Secondary pulmonary hypertension in chronic heart failure - The role of the endothelium in pathophysiology and management
Secondary pulmonary hypertension in chronic heart failure - The role of the endothelium in pathophysiology and management
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DOI：
10.1161/01.cir.102.14.1718
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发表时间：
2000-10-03
期刊：
影响因子：
37.8
通讯作者：
Givertz, MM
中科院分区：
文献类型：
--
作者：
Moraes, DL;Colucci, WS;Givertz, MM
由于血管平滑肌张力失调和结构重塑，慢性左心室衰竭患者的肺血管阻力经常升高。前者可以通过药物血管扩张剂在几分钟到几天内逆转，而后者相对固定，可能只能缓慢消退，需要数月至数年的时间。这些异常至少部分是由于肺血管内皮功能障碍导致一氧化氮可用性受损和内皮素表达增加。在慢性心力衰竭患者中，由此产生的肺动脉高压直接影响右心室功能，并可能影响运动能力、发病率和死亡率。新的治疗策略，包括使用增加一氧化氮可用性或对抗内皮素作用的药物，可能会改善慢性心力衰竭患者的肺血管系统的结构和功能。
Pulmonary vascular resistance is frequently elevated in patients with chronic left ventricular failure as a result of dysregulation of vascular smooth muscle tone and structural remodeling. The former is reversible over a period of minutes to days by pharmacological vasodilators, whereas the latter is relatively fixed and may resolve only slowly, over months to years. These abnormalities are due, at least in part, to pulmonary vascular endothelial dysfunction that results in impaired nitric oxide availability and increased endothelin expression. In patients with chronic heart failure, the resulting pulmonary hypertension directly affects right ventricular function and may affect exercise capacity, morbidity, and mortality. New treatment strategies, which include the use of agents that increase nitric oxide availability or oppose the actions of endothelin, may improve the structure and function of the pulmonary vasculature in patients with chronic heart failure.