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Management of pulmonary hypertension in left heart disease

机译:左心疾病中肺动脉高压的管理

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Pulmonary hypertension (PH) due to left heart disease is classified as group II according to the Dana Point classification, which includes left ventricular systolic and/or diastolic left heart failure, and left-sided valvular disease. PH due to left heart disease is the most common cause and when present, especially with right ventricular dysfunction, is associated with a worse prognosis. Left heart disease with secondary PH is associated with increased left atrial pressure, which causes a passive increase in pulmonary pressure. Passive PH could be superimposed by an active protective, and in some patients by an ‘out of proportion’, elevated precapillary pulmonary vasoconstriction and vascular remodelling which leads to greater or lesser further increase of the pulmonary artery pressure. In this review, epidemiological and pathophysiologic mechanisms for the development of group II PH are summarized. The conflicting data about the haemodynamic and possible parameters to diagnose passive versus reactive and ‘out of proportion’ PH are presented. The different therapeutic concepts, along with novel treatment strategies, are reviewed in detail and critically discussed regarding their effectiveness and safety.
机译:根据Dana Point分类,将因左心疾病引起的肺动脉高压(PH)归为II组,其中包括左心收缩和/或舒张性左心衰竭和左侧瓣膜病。左心脏疾病引起的PH是最常见的原因,当存在时,尤其是右心功能不全时,与预后较差有关。患有继发性PH的左心疾病与左心房压升高有关,这会导致肺动脉压被动升高。被动PH可以被主动保护所覆盖,在某些患者中被“比例失调”,毛细血管前肺血管收缩和血管重构升高所导致,这或多或少会导致肺动脉压力的进一步升高。在这篇综述中,总结了II型PH发展的流行病学和病理生理机制。提出了关于血流动力学和可能的参数的矛盾数据,这些参数可用于诊断被动与反应性和“不成比例的” PH。我们将详细审查不同的治疗概念以及新颖的治疗策略,并就其有效性和安全性进行严格讨论。

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