Pulmonary Arterial Hypertension: Diagnosis, Treatment, and Novel Advances
Pulmonary Arterial Hypertension: Diagnosis, Treatment, and Novel Advances
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DOI：
10.1164/rccm.202012-4317so
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发表时间：
2021-06-15
影响因子：
24.7
通讯作者：
Rosenzweig, Erika B.
中科院分区：
文献类型：
--
作者：
Maron, Bradley A.;Abman, Steven H.;Rosenzweig, Erika B.
肺动脉高压（PAH）的诊断和治疗取得了一些进展，例如对肺外血管器官系统累及的更广泛认识，验证的护理点临床评估工具，以及对适当患者早期启动多种药物治疗的关注。事实上，目前PAH的主要目标是早期诊断，及时开始治疗，以实现最小的症状负担；优化患者的生化、血流动力学和功能概况；减少不良事件。为了实现这一目标，临床医生必须熟悉新的危险因素和修订的多环芳烃血液动力学定义。对发育生物学（即围产期健康）的作用的新见解也可能有助于预测成年早期发生的多环芳烃。紧急或未充分利用的PAH治疗方法包括新型tgf - β配体陷阱药物治疗、远程肺动脉压监测、使用惰性气体核磁共振和其他技术的下一代成像、右心房起搏和肺动脉去神经控制。这里总结了这些和其他多环芳烃的最新进展，以供更广泛的肺医学界使用。
The diagnosis and management of pulmonary arterial hypertension (PAH) includes several advances, such as a broader recognition of extrapulmonary vascular organ system involvement, validated point-of-care clinical assessment tools, and focus on the early initiation of multiple pharmacotherapeutics in appropriate patients. Indeed, a principal goal in PAH today is an early diagnosis for prompt initiation of treatment to achieve a minimal symptom burden; optimize the patient's biochemical, hemodynamic, and functional profile; and limit adverse events. To accomplish this end, clinicians must he familiar with novel risk factors and the revised hemodynamic definition for PAH. Fresh insights into the role of developmental biology (i.e., perinatal health) may also be useful for predicting incident PAH in early adulthood. Emergent or underused approaches to PAH management include a novel TGF-beta ligand trap pharmacotherapy, remote pulmonary arterial pressure monitoring, next-generation imaging using inert gas-based magnetic resonance and other technologies, right atrial pacing, and pulmonary arterial denervation. These and other PAH state of the art advances are summarized here for the wider pulmonary medicine community.