Risikostratifizierung und Behandlungsziele bei pulmonalarterieller Hypertonie

Zusammenfassung

Die Risikostratifizierung hat eine wichtige Rolle bei der Vorhersage von Ergebnissen und der Steuerung der Behandlung von Patient*innen mit pulmonalarterieller Hypertonie (PAH). Die 3 wichtigsten nicht-invasiven prädiktiven Prognosefaktoren sind die Funktionsklasse der Weltgesundheitsorganisation, die 6-Minuten-Gehstrecke und die natriuretischen Peptide. Alle 3 sind in allen derzeit validierten Risikostratifizierungsinstrumenten enthalten. Aufgrund von Einschränkungen, die hauptsächlich mit der reduzierten Spezifität der Schwere der PAH zusammenhängen, sind diese Variablen jedoch nicht immer ausreichend, um individuelle Behandlungsentscheidungen zu treffen. Darüber hinaus wird erwartet, dass Marker, die mit pulmonal-vaskulärem Remodelling assoziiert sind, mit effektiven Kombinations- und neuen PAH-Therapien zunehmend relevant werden, um die Behandlung von Patient*innen mit PAH zu steuern. Während das Erreichen eines niedrigen Mortalitätsrisikos, bewertet mit einem validierten Risikoinstrument, ein wichtiges Behandlungsziel bleibt, deuten vorläufige Daten darauf hin, dass invasive Hämodynamik und kardiale Bildgebung einen zusätzlichen Wert bei der Steuerung von Behandlungsentscheidungen bieten können.

Abstract

Risk stratification plays an important role in predicting outcomes and guiding treatment decisions of patients with pulmonary arterial hypertension (PAH). The three most important non-invasive predictive prognostic factors are the World Health Organization functional class, the 6-minute walk distance, and natriuretic peptides. These three are included in all currently validated risk stratification tools. However, due to limitations primarily related to the reduced specificity of PAH severity, these variables are not always sufficient to guide individual treatment decisions. Furthermore, with effective combination and new PAH therapies, markers associated with pulmonary vascular remodeling are expected to become increasingly relevant for guiding the treatment of patients with PAH. While achieving a low mortality risk, measured with a validated risk assessment tool, remains an important treatment goal, preliminary data suggest that invasive hemodynamics and cardiac imaging may provide additional value in guiding treatment decisions.

Schlüsselwörter

pulmonale Hypertonie - pulmonalarterielle Hypertonie - Risikostratifizierung - Prognose - Prognosefaktoren

Keywords

pulmonary hypertension - pulmonary arterial hypertension - risk stratification - prognosis - outcome predictors

Publication History

Article published online:
06 October 2025

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