Cardiopulmonary Hemodynamics in Pulmonary Hypertension and Heart Failure JACC Review Topic of the Week

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:76

Review

Maron, Bradley A.^1,2  Kovacs, Gabor^3,4  Vaidya, Anjali⁵  Bhatt, Deepak L.¹  Nishimura, Rick A.⁶  Mak, Susanna⁷  Guazzi, Marco^8,9  Tedford, Ryan J.¹⁰ 

[1] Brigham & Womens Hosp, Div Cardiovasc Med, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA

[2] VA Boston Healthcare Syst, Dept Cardiol, West Roxbury, MA USA

[3] Med Univ Graz, Dept Internal Med, Div Pulmonol, Graz, Austria

[4] Ludwig Boltzmann Inst Lung Vasc Res, Graz, Austria

[5] Temple Univ, Lewis Katz Sch Med, Pulm Hypertens Right Heart Failure & CTEPH Progra, Philadelphia, PA 19122 USA

[6] Mayo Clin, Coll Med, Div Cardiovasc Dis, Rochester, MN USA

[7] Univ Toronto, Dept Med, Div Cardiol, Toronto, ON, Canada

[8] Univ Milan, Cardiol Univ Dept, Milan, Italy

[9] IRCCS San Donato Hosp, Rome, Italy

[10] Med Univ South Carolina, Dept Med, Div Cardiol, Charleston, SC 29425 USA

关键词: heart failure;    hemodynamics;    pulmonary hypertension;   

DOI  :  10.1016/j.jacc.2020.10.007

来源: Elsevier

【 摘 要 】

Pulmonary hypertension (PH) is an independent risk factor for adverse clinical outcome, particularly in left heart disease (LHD) patients. Recent advances have clarified the mean pulmonary artery pressure (mPAP) range that is above normal and is associated with clinical events, including mortality. This progress has for the first time resulted in a new clinical definition of PH that is evidenced-based, is inclusive of mPAP >20 mm Hg, and emphasizes early diagnosis. Additionally, pulmonary vascular resistance (PVR) 2.2 to 3.0 WU, considered previously to be normal, appears to associate with elevated clinical risk. A revised approach to classifying PH patients as pre-capillary, isolated post-capillary, or combined pre-/post-capillary PH now guides point-of-care diagnosis, risk stratification, and treatment. Exercise hemodynamic or confrontational fluid challenge studies may also aid decision-making for patients with PH-LHD or otherwise unexplained dyspnea. This collective progress in pulmonary vascular and heart failure medicine reinforces the critical importance of accurate hemodynamic assessment. Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

Free