Pulmonale Hypertonie bei Linksherzerkrankungen

Kai Helge Schmidt; Joana Adler; Olympia Bikou; Ralf Felgendreher; Wolfgang Hohenforst-Schmidt; Stephan Holt; Franz X. Kleber; Dennis Ladage; Mona Lichtblau; Elena Pfeuffer-Jovic; Julian Pott; Andreas Rieth; Alexander Schmeisser; Katharina Schnitzler; Stefan Stadler; Wolfgang M. Kuebler; Rüdiger Blindt; Christian Opitz

doi:10.1055/a-2625-4920

Pneumologie, Inhaltsverzeichnis

Pneumologie 2025; 79(10): 787-796
DOI: 10.1055/a-2625-4920

Übersicht

Pulmonale Hypertonie bei Linksherzerkrankungen

Pulmonary Hypertension Associated with Left Heart Disease

Authors

Kai Helge Schmidt

¹Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland

²Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland
Joana Adler

³Klinik III für Innere Medizin, Uniklinik Köln, Köln, Deutschland

⁹Klinik für Pneumologie, Kliniken Maria Hilf Mönchengladbach, Mönchengladbach, Deutschland
Olympia Bikou

⁴Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, München, Deutschland
Ralf Felgendreher

⁵Klinik für Kardiologie, KRH Standort Neustadt am Rübenberge, Deutschland
Wolfgang Hohenforst-Schmidt

⁶Innere II, Märkische Kliniken, Lüdenscheid, Deutschland
Stephan Holt

⁷Praxis am Steintor, Recklinghausen, Deutschland
Franz X. Kleber

⁸Deutsches Herzzentrum der Charité, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
Dennis Ladage

⁹Klinik für Pneumologie, Kliniken Maria Hilf Mönchengladbach, Mönchengladbach, Deutschland
Mona Lichtblau

¹⁰Klinik für Pneumologie, Zentrum für Pulmonale Hypertonie, Universitätsspital, Zürich, Schweiz
Elena Pfeuffer-Jovic

¹¹Klinikum Würzburg Mitte, Standort Missioklinik Würzburg, Würzburg, Deutschland
Julian Pott

¹²II. Medizinische Klinik und Poliklinik, UKE Hamburg
Andreas Rieth

¹³Abteilung für Kardiologie, Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, Deutschland
Alexander Schmeisser

¹⁴Zentrum für Innere Medizin, Universitätsklinik für Kardiologie und Angiologie Magdeburg, Magdeburg, Deutschland
Katharina Schnitzler

¹Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin Mainz, Mainz, Deutschland

²Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland
Stefan Stadler

¹⁵Klinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Deutschland
Wolfgang M. Kuebler

¹⁶Institute of Physiology, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
Rüdiger Blindt^*

¹⁷Kardio Bremen, Rotes Kreuz Krankenhaus Bremen, Bremen, Deutschland
Christian Opitz^*

¹⁸Klinik für Innere Medizin – Kardiologie, DRK Kliniken Berlin Westend, Berlin, Deutschland

Abstract

Zusammenfassung

Linksherzerkrankungen (LHD) sind die häufigste Ursache einer pulmonalen Hypertonie (PH), die weiter in isolierte postkapilläre PH (IpcPH) und kombinierte prä- und postkapilläre PH (CpcPH) unterteilt wird.

Mit dem Ziel Behandlungsansätzen näherzukommen, setzte die PH-LHD-Arbeitsgruppe des 7. Welt-Symposiums zur pulmonalen Hypertonie einen stärkeren Fokus auf die Phänotypisierung, Subtypisierung und die ausdifferenziertere Betrachtungsweise des breiten Spektrums der PH-LHD. Mit dieser Intention wurde ein 4-stufiges PH-LHD-System erarbeitet, in dem jede Stufe (A = Risiko, B = strukturelle Herzerkrankung, C = symptomatische Herzerkrankung, D = fortgeschritten) durch spezifische pathophysiologische, hämodynamische, klinische und letztendlich auch therapeutische Strategien gekennzeichnet ist. In diesem Kontext wird zudem auf zur PH-LHD führende kardiologische Krankheitsbilder mit spezifischen Therapieansätzen, wie die Mitral- und Aortenklappenstenose sowie ausgewählte Kardiomyopathien, ein Augenmerk gerichtet. Ebenso wird die Überschneidung mit anderen PH-Gruppen wie der CTEPH und der PH bei Lungenerkrankungen betont und konkretisiert. Der therapeutische Einsatz von PAH-Medikamenten, die einen pulmonalvaskulären Ansatz haben, kann anhand von Ergebnissen randomisierter klinischer Studien weiterhin außerhalb klinischer Studien nicht empfohlen werden.

Abstract

Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH), which is further categorised into isolated post-capillary PH (IpcPH) and combined pre- and post-capillary PH (CpcPH).

With the aim of developing treatment strategies, the PH-LHD working group of the 7^th World Symposium on Pulmonary Hypertension placed a stronger focus on phenotyping, subtyping and a more differentiated approach to the broad spectrum of PH-LHD. With this intention, a four-stage PH-LHD system was developed in which each stage (A = risk, B = structural heart disease, C = symptomatic heart disease, D = advanced) is characterised by specific pathophysiological, haemodynamic, clinical and ultimately therapeutic strategies. In this context, attention is also paid to cardiac diseases leading to PH-LHD with specific therapeutic approaches, such as mitral and aortic valve stenosis and selected cardiomyopathies. The overlap with other PH groups such as CTEPH and PH in lung diseases is also emphasised and specified. The therapeutic use of PAH drugs that have a pulmonary vascular approach can still not be recommended outside of clinical trials.

Schlüsselwörter

Linksherzerkrankung - Stenose - Ejektionsfraktion - postkapilläre pulmonale Hypertonie

Keywords

left heart disease - stenosis - ejection fraction - postcapillary pulmonary hypertension

Volltext

Referenzen

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