左心功能不全继发的肺动脉高压

Pulmonary Hypertension Secondary to Left Heart Dysfunction: A Review

左心功能不全继发的肺动脉高压是指左心功能不全所导致的肺静脉回流受阻及左室充盈压力升高继发的肺动脉高压,在美国Dana point2008诊断分类中归为肺动脉高压的第二型,该型包括左心收缩、舒张功能不全及心脏瓣膜疾病相关的肺动脉高压。该病的发病率和死亡率高,而肺动脉高压的出现预示该病预后不佳。该病病理生理机制复杂,最重要的表现是肺循环压力被动性升高,以及肺血管的反应性收缩和重构。诊断有赖于病史,体征,心脏彩超,右心导管检测等辅助检查。该病的治疗重点在于治疗原发的左心疾病(比如治疗心衰和瓣膜置换手术),目前没有证据支持特异性的抗肺动脉高压药物的有效性,但研究显示PDE-5抑制剂(如西地那非)是一种有治疗前景的药物,但其安全性和有效性还有待进一步前瞻性,随机对照试验评价。本文将对左心系统疾病相关的肺动脉高压的疾病定义,流行病学特点,病因,诊断,治疗等方面进行综述。

Pulmonary hypertension secondary to left heart dysfunction （LHD-PH） is characterized by uncompleted reflux of pul- monary venous system, increased left ventricular filling pressure caused by left heart failure, leading to an elevation of pulmonary pres- sure. LHD-PH is defined as a Group II PH according to the American Dana point 2008 classification and secondary to left ventricular or diastolic dysfimction, or valvular heart disease. LHD-PH is associated with high mobility and mortality, in which the manifestation of pul- monary hypertension predicts a poor prognosis. Pathophysiologic mechanisms of LHD-PH are complex, involving primary the passive in- crease in pulmonary arterial pressure due to insufficient reflux, as well as reactive vasoconstriction and structural remolding. Diagnosis relied on history record, physical signs and echocardiography and fight hear catheter test. Treatment of these patients is to cure on the pri- mary left heart disease （ameliorate cardiac performance and valvular surgery）, and there is no direct evidence to affirm the efficacy of PH-specific therapies in patients with LHD-PH. However, recent studies suggest that sildenafil, a PDE-5 inhibitors, is a promising agent, but its safety and efficacy needs to be evaluated in prospective, randomized clinical trials. In this paper, we extensively reviewed the epi- demiology, mechanisms, diagnostic approaches and treatment strategies of the LHD-PH.