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2022 ESC/ERS-Leitlinien zur Diagnostik und Therapie der pulmonalen Hypertonie

Ein fokussierter Überblick

2022 ESC/ERS guidelines on the diagnostics and treatment of pulmonary hypertension

A focussed review

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Zusammenfassung

Die pulmonale Hypertonie (PH) ist ein hämodynamischer Zustand, der durch eine Reihe zugrunde liegender Erkrankungen bedingt sein kann. Die Pathophysiologie ist komplex und betrifft diverse Organsysteme, sodass ein multidisziplinärer Ansatz bezüglich einer differenzialdiagnostischen Abklärung und Behandlung notwendig ist. Dieser Übersichtsartikel bietet einen Überblick über die wichtigsten Änderungen der aktualisierten ESC(European Society of Cardiology)/ERS(European Respiratory Society)-Leitlinie zur Diagnostik und Therapie der PH im Vergleich zur letzten Version aus 2015. Ein spezieller Fokus liegt dabei (i) auf den geänderten hämodynamischen Definitionen der PH (inkl. genereller Definition, prä- vs. postkapilläre PH, isoliert postkapilläre PH [IpcPH], kombiniert post- und präkapilläre PH [CpcPH]), (ii) auf der klinischen Präsentation und Klassifikation der PH, (iii) auf dem diagnostischen Vorgehen sowie (iv) auf speziellen Aspekten der pulmonal arteriellen Hypertonie (PAH; Gruppe 1), der PH bei zugrunde liegender Linksherz- (Gruppe 2) oder Lungenerkrankung (Gruppe 3) und der chronisch thromboembolischen PH (CTEPH; Gruppe 4). Für Letztere werden das spezielle diagnostische Vorgehen sowie der multimodale Therapieansatz dargelegt. Zudem werden für jede der PH-Gruppen klinisch relevante Aspekte und Neuerungen kurz und prägnant dargestellt.

Abstract

Pulmonary hypertension (PH) is a hemodynamic state that can be caused by a variety of underlying conditions. The pathophysiology is complex and can involve several organ systems, requiring a multidisciplinary approach to differential diagnostics and management. This review article provides a comprehensive overview of the most important changes in the updated 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnostics and treatment of pulmonary hypertension, as compared to the previous 2015 version. A special focus is on (i) updated hemodynamic definitions of PH, including general definition, precapillary vs. postcapillary PH, isolated postcapillary PH (IpcPH), combined postcapillary and precapillary PH (CpcPH), (ii) the clinical presentation and classification of PH, (iii) the diagnostic approach as well as (iv) specific aspects of pulmonary arterial hypertension (PAH, group 1), including risk assessment, treatment and PAH with comorbidities, PH associated with left heart (group 2) or lung disease (group 3), and chronic thromboembolic pulmonary hypertension (CTEPH, group 4). Regarding the latter, the specific diagnostic algorithm and the multimodal approach to treatment are presented. Finally, for each of the PH groups, clinically relevant aspects and innovations are briefly and concisely presented.

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  1. Klinik III für Innere Medizin (Kardiologie), Zentrum für Molekulare Medizin Köln (ZMMK), Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Stephan Rosenkranz

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Correspondence to Stephan Rosenkranz.

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S. Rosenkranz hat Honorare für Vorträge und/oder Beratertätigkeiten erhalten von: Abbott, Acceleron, Actelion, Aerovate, Altavant, AOP Orphan, AstraZeneca, Bayer, Boehringer Ingelheim, Edwards, Ferrer, Gossamer, Janssen, MSD, United Therapeutics und Vifor; seine Institution hat Forschungsgelder erhalten von: Actelion, AstraZeneca, Bayer und Janssen.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rosenkranz, S. 2022 ESC/ERS-Leitlinien zur Diagnostik und Therapie der pulmonalen Hypertonie. Herz 48, 23–30 (2023). https://doi.org/10.1007/s00059-022-05155-1

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