Pulmonale Hypertonie bei Linksherzerkrankungen

Zusammenfassung

Eine pulmonale Hypertonie (PH) kann bei mehr als der Hälfte aller Patienten mit schwerer chronischer Linksherzinsuffizienz auftreten. Diese Form der PH gehört zur Gruppe 2 der WHO-Klassifikation, für deren Behandlung aktuell keine Medikamente zur Verfügung stehen, um gezielt einen erhöhten pulmonal-vaskulären Gefäßwiderstand zu beeinflussen. Im Vordergrund steht die Behandlung der zugrundeliegenden Störung. Trotz teilweise positiver Akuteffekte zeigten chronische Therapiestudien mit Prostanoiden oder Endothelinrezeptor-Antagonisten bei diesen Patienten enttäuschende Ergebnisse. Im Gegensatz dazu liegen erste positive Resultate mit dem Phosphodiesterase-5-Inhibitor (PDE-5-I) Sildenafil vor. Sowohl nach der Akutgabe als auch unter einer chronischen Therapie über bis zu 6 Monaten bewirkte die Substanz bei Patienten mit chronischer Herzinsuffizienz (CHI) eine signifikante Verbesserung der Hämodynamik, Leistungsfähigkeit und Atemeffizienz bei günstigem Nebenwirkungsprofil. Bis zum Vorliegen größerer kontrollierter Studien sollten Patienten mit CHI jedoch nach den aktuellen Leitlinien behandelt werden.

Summary

Pulmonary hypertension (PH) is a relatively common hemodynamic finding in patients with left-sided heart disease and is usually associated with increased morbidity and mortality. However, so far no study has demonstrated long-term benefit from drugs specifically designed to improve pulmonary hemodynamics. There are currently no consensus recommendations on the management of PH in patients with chronic left heart failure. Most importantly, the underlying cause of left heart disease should be treated first.

While previous studies with endothelin receptor antagonists or epoprostenol have been disappointing, initial promising results have been published for the phosphodiesterase-5 inhibitor sildenafil. Following acute administration and with chronic therapy for up to 6 months sildenafil improved hemodynamic parameters and exercise capacity in patients with PH and chronic left heart failure. Until the results from larger randomized controlled trials become available, the treatment of chronic left heart failure should follow the current guidelines.

Schlüsselwörter

pulmonale Hypertonie - Herzfehler - Phosphodiesterase-Inhibitor - Gefäßremodeling

Keywords

pulmonary hypertension - heart failure - phosphodiesterase inhibitor - vascular remodeling

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