The Effects of Vasodilators in Pulmonary Hypertension Pulmonary Vascular or Peripheral Vascular?
The Effects of Vasodilators in Pulmonary Hypertension Pulmonary Vascular or Peripheral Vascular?
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DOI：
10.1161/circheartfailure.108.805374
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发表时间：
2009-03-01
影响因子：
9.7
通讯作者：
Rich, Stuart
中科院分区：
文献类型：
--
作者：
Rich, Stuart
当原发性肺动脉高压（PPH）首次在医学文献中描述时，其特征是对一名年轻女性进行心导管检查，其肺动脉压不明原因升高，在静脉注射乙酰胆碱后迅速下降。 1 对这一现象的前哨描述导致人们接受 PPH 作为一个以不适当的肺血管收缩为核心特征的医学实体。 2 此后，许多系列的 PPH（现在称为特发性肺动脉高压 [IPAH]）患者相继发表，这些患者对急性血管扩张剂的反应能力各不相同。尽管治疗方法强调了反应者或无反应者的初始分类，但大多数患者对血管扩张剂的反应仅表现出肺压（PAP）小幅下降。 3 然而，根据将 6 分钟步行 (6 MW) 测试的反应作为主要终点的临床试验，血管扩张剂被广泛用于无反应的患者。 4 6 MW 的持续改善反映了运动不耐受的复杂性，这可能不仅受到心肺因素的强烈影响，而且还受到肌肉运动反射等外周因素的强烈影响。 5
When primary pulmonary hypertension (PPH) was first described in the medical literature, it was characterized from a cardiac catheterization on a young woman who had an elevated pulmonary arterial pressure of unknown origin which, after the intravenous administration of acetylcholine, promptly fell. 1 The sentinel description of this phenomenon led to the acceptance of PPH as a medical entity in which inappropriate pulmonary vasoconstriction was a central feature. 2 Since then many series of patients with PPH (now referred to as idiopathic pulmonary arterial hypertension [IPAH]) have been published which document a variable ability to respond to acute vasodilator challenge. Although, the approach to therapy has emphasized the initial classification of responder or nonresponder, most patients demonstrate only a small decrease in pulmonary pressure (PAP) in response to vasodilators. 3 However, vasodilators are widely prescribed in patients who are nonresponders, based on clinical trials that established the response to a 6-minute walk (6 MW) test as the primary end point. 4 The consistent improvement in 6 MW reflects the complexity of exercise intolerance, which may be strongly influenced not only by cardiopulmonary factors, but by peripheral factors such as the muscle ergoreflex. 5