Diagnosis and differential assessment of pulmonary arterial hypertension
Diagnosis and differential assessment of pulmonary arterial hypertension
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DOI：
10.1016/j.jacc.2004.02.032
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发表时间：
2004-06-16
影响因子：
24
通讯作者：
Gaine, S
中科院分区：
文献类型：
--
作者：
Barst, RJ;McGoon, M;Gaine, S
肺动脉高压 (PAH) 通过对诊断至关重要的各种检查以及其他检查来诊断，以明确肺动脉高压 (PH) 的类别。诊断算法可以指导 PH 的评估，但与所有指南一样，该算法可以根据具体的临床情况进行修改。大多数患者是通过症状评估而被诊断出来的，而其他患者则是在筛查无症状高危人群时被诊断出来的。疑似 PH 患者必须进行右心导管检查 (RHC)，以明确诊断并记录肺血流动力学。在开始药物治疗之前，有必要评估急性血管反应性（导管插入期间），以确定适合个体患者的适当治疗方法。急性反应通常定义为平均肺动脉压降低至少10毫米汞柱，平均肺动脉压降低至40毫米汞柱或更低，并伴有正常或高心输出量。 PAH 确诊后，应评估疾病严重程度，以便准确确定各种治疗方案的风险：获益情况。预测结果的有用工具包括功能等级、运动能力、肺血流动力学、急性血管反应性、右心室功能以及脑钠尿肽、内皮素-1、尿酸和肌钙蛋白水平。在治疗中连续重复这些测试对于监测给定治疗的反应很有用。建议在专门从事 PH 管理的中心进行密切随访，并定期仔细重新评估和调整治疗。 (C) 2004 年由美国心脏病学会基金会资助。
Pulmonary arterial hypertension (PAH) is diagnosed by various investigations that are essential for making the diagnosis, and by additional tests to clarify the category of pulmonary hypertension (PH). A diagnostic algorithm can guide the evaluation of PH, but like all guidelines the algorithm can be modified according to specific clinical circumstances. Most patients are diagnosed as the result of an evaluation of symptoms, whereas others are diagnosed during screening of asymptomatic populations at risk. Right heart catheterization (RHC) must be performed in patients with suspected PH to establish the diagnosis and document pulmonary hemodynamics. Before initiation of medical therapy, assessment of acute vasoreactivity (during catheterization) is necessary to determine the appropriate therapy for an individual patient. An acute response is generally defined as a decrease in mean pulmonary arterial pressure of at least 10 mm Hg with the mean pulmonary arterial pressure decreasing to 40 mm Hg or below, accompanied by a normal or high cardiac output. After PAH is diagnosed, disease severity should be assessed in order to accurately determine risk:benefit profiles for various therapeutic options. Useful tools to predict outcome include functional class, exercise capacity, pulmonary hemodynamics, acute vasoreactivity, right ventricular function, as well as brain natriuretic peptide, endothelin-1, uric acid, and troponin levels. Repeating these tests serially on treatment is useful for monitoring the response to a given therapy. Close follow-up at a center specializing in management of PH is recommended, with careful periodic reassessment and adjustment of therapy. (C) 2004 by the American College of Cardiology Foundation.