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原作者： Semhar Tewelde；郑辛甜翻译 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2015-01-09
Title: Heart Failure & Pulmonary Hypertension (Part I)
题目：心力衰竭和肺动脉高压（Part I）
Author 作者: Semhar Tewelde
翻译：郑辛甜 校对：肖锋
~50% of patients with heart failure & preserved ejection fraction (HFpEF) develop pulmonary hypertension (PH). HFpEF with PH portends reduced survival and increased hospitalization rates compared to those without PH. HFpEF-PH is often confused with idiopathic pulmonary hypertension (IPAH) given the similar hemodynamics; differentiating them is challenging and requires careful consideration of clinical, radiologic, and hemodynamic data.
50%的射血分数正常型心力衰竭（HFpEF）患者将出现肺动脉高压（PH）。HFpEF合并PH患者与不合并PH的患者比较，生存率降低，住院率升高。HFpEF-PH与特发性肺动脉高压（IPAH）血流动力学类似，因此常被混淆，区分它们有一定的难度，需要仔细审视临床、影像和血流动力学资料。
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IPAH |
HFpEF-HP |
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Clinical parameters 临床指标: |
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Age 年龄 |
Typically 3rd–5th decade 通常30~50岁 |
Typically 6th–8th decade 通常60~80岁 |
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Comorbidities 合并症(HTN, HLD, DM, CAD) |
Rare 罕见 |
Common 常见 |
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Atrial arrhythmias房性心律失常 |
Rare罕见 |
Common常见 |
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Obstructive sleep apnea阻塞性睡眠呼吸暂停 |
Rare罕见 |
Common常见 |
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Echocardiographic parameters 超声心动图指标: |
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LA size/volume左房内径/容量 |
Normal正常 |
Increased增加 |
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LV diastolic function 左室舒张功能 |
Normal to mildly abnormal正常或轻度异常 |
Moderate to severely abnormal 中度至严重异常 |
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Hemodynamic parameters 血流动力学指标: |
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Resting PAWP静息PAWP |
Always <15 mmHg 通常< 15 mmHg |
May be < or >15 mmHg 可能大于或小于15 mmHg |
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Response to volume容量反应 |
PAWP <15 mmHg (increase增加≤5 mmHg) |
PAWP >15 mmHg (increase 增加>5 mmHg) |
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Response to exercise运动反应 |
PAWP <15 mmHg (increase增加≤5 mmHg) |
PAWP >15 mmHg (increase增加>5 mmHg) |
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References参考文献:
Kanwar M, Tedford RJ, Agarwal R, et al. Management of Pulmonary Hypertension due to Heart Failure with Preserved Ejection Fraction. Current Hypertension Reports. 2014 Dec;16(12):501. doi: 10.1007/s11906-014-0501-5.
