Taking it to heart: dissecting cardiopulmonary interactions in diseases of the lung and the cardiovascular system.
Taking it to heart: dissecting cardiopulmonary interactions in diseases of the lung and the cardiovascular system.
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牢记于心：剖析肺部和心血管系统疾病中的心肺相互作用。
DOI：
10.1152/ajplung.00373.2020
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Lahm,Tim
中科院分区：
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作者：
Lahm,Tim
世界心脏日，每年9月29日庆祝，由世界心脏联合会建立，以提高对心血管疾病（CVD）的认识（7）。CVD确实是一种全球性疾病，影响着全世界数百万人。虽然CVD的类型和表现在世界某些地区之间不同，但各种CVD都具有导致显著发病率和死亡率的不幸特征。此外，心血管疾病可能会深刻影响受影响个体的生活质量，并使受影响个体更容易在新出现的疾病（如COVID-19）中遭受不利的结果（14，31）。毫不奇怪，CVD的公共卫生相关性和财政后果是巨大的。Maarman等人在本期AJP Lung（20）的社论中雄辩地概述了CVD在世界各地的影响，解决几个主要知识和治疗差距的策略，以及世界心脏联盟在解决CVD负担方面的作用。作者提醒我们，20年后，世界心脏日的重要性仍然突出。尽管心血管疾病无疑是全球健康的一个主要负担，但人们可能会想，为什么像AJP Lung这样的肺部杂志会突出世界心脏日，为什么肺病学家会写一篇社论。答案很简单：几乎所有的肺部疾病都有可能影响心脏的右侧（12）。在急性和慢性肺部疾病中均可观察到这种右心受累，可能间接和间接发生[通常是急性和/或慢性肺动脉高压（PH）发展的结果]或伴随发生[通过靶向肺和心脏的病理生理过程，例如吸烟暴露、化疗药物的副作用、脓毒症中的微血管血栓形成，和/或急性呼吸窘迫综合征（ARDS）]。此外，几种常见疾病如糖尿病、高脂血症和阻塞性睡眠呼吸暂停会诱导广泛的内皮细胞功能障碍，并同时靶向和影响肺和心脏（右心和左心）。事实上，暴露于香烟烟雾的受试者的右心异常甚至可能在观察到肺部疾病的迹象之前发生（27）。关于急性或慢性肺部疾病中的PH发展，重要的是要注意，无论潜在的肺部疾病是什么，一旦PH和肺心病发展，受影响个体的发病率和死亡率显着增加（2，5，21，25）。另一个有趣的观察结果是，尽管慢性肺病中右心受累的“典型”表型是右心室（RV）增大和肥大以及右心房扩张，但在慢性阻塞性肺病（COPD）患者的一个亚组中，已经描述了小而萎缩的右心（11），可能代表心脏减少症的过程，其可能类似于在该患者群体中可见的肌肉减少症。另一方面，人们早就知道任何类型的左心脏疾病都可能导致肺部疾病和右心脏异常（24）。这通常通过PH的发展和随后的右心充血发生。此外，鉴于共用心包囊以及共用心肌纤维，与左心扩大相关的机械变化可能直接影响RV的几何形状和力学，从而导致RV功能障碍。在这种情况下，值得注意的是，室间隔对RV射血分数的贡献约为40%（26）。除了PH，肺可能会受到左心脏病通过...
World Heart Day, celebrated annually on September 29, was established by the World Heart Federation to generate awareness of cardiovascular disease (CVD)(7). CVD truly is a global disease that affects millions of people worldwide. Although the types and manifestations of CVD differ between certain parts of the world, the various CVDs share the unfortunate feature of leading to significant morbidity and mortality. In addition, CVDs may profoundly affect the quality of life of affected individuals and make affected individuals more prone to suffering unfavorable outcomes in emerging diseases such as COVID-19 (14, 31). Not surprisingly, the public health relevance and fiscal consequences of CVDs are substantial. The impact of CVD across the world, strategies for addressing several of the major knowledge and treatment gaps, and the role of the World Heart Federation in addressing the burden of CVD are outlined eloquently in an editorial by Maarman et al. in this issue of AJP Lung (20). The authors remind us that after 20 years the importance of World Heart Day is still eminent. Although CVD without a doubt represents a major global health burden, one may wonder why a pulmonary journal such as AJP Lung is highlighting World Heart Day and why a pulmonologist is writing an accompanying editorial. The answer is easy: nearly all pulmonary diseases have the potential to affect the right side of the heart (12). This right heart involvement, which can be observed in acute as well as chronic lung disease, may either occur indirectly and subsequentially [usually as a consequence of the development of acute and/or chronic pulmonary hypertension (PH)] or concomitantly [through a pathophysiological process that targets both the lung and heart, eg, cigarette smoke exposure, side effects of chemotherapeutics, microvascular thrombosis in sepsis, and/or acute respiratory distress syndrome (ARDS)]. In addition, several common diseases such as diabetes, hyperlipidemia, and obstructive sleep apnea induce widespread endothelial cell dysfunction and simultaneously target and affect both the lung as well as the heart (both the right and left heart). In fact, right heart abnormalities in subjects exposed to cigarette smoke may occur even before signs of lung disease are observed (27). With regard to PH development in acute or chronic lung disease, it is important to note that, no matter what the underlying lung disease is, as soon as PH and cor pulmonale develop, morbidity and mortality of affected individuals increase significantly (2, 5, 21, 25). Another interesting observation is that, although the“typical” phenotype of right heart involvement in chronic lung disease is that of an enlarged and hypertrophied right ventricle (RV) and a dilated right atrium, in a subset of patients with chronic obstructive pulmonary disease (COPD), a small and atrophied right heart has been described (11), possibly representing a process of cardiopenia that may be similar to the sarcopenia that can be seen in this patient population. On the other hand, it has long been known that any type of left heart disease can cause lung disease and right heart abnormalities (24). This typically occurs through the development of PH and subsequent right heart congestion. In addition, given the shared pericardial sac as well as shared myocardial fibers, mechanical changes associated with left heart enlargement may directly affect the geometry and mechanics of the RV, thus leading to RV dysfunction. In this context, it is worthwhile noting that the interventricular septum contributes~ 40% to the RV ejection fraction (26). In addition to PH, the lung may be affected by left heart disease through the …