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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Priv.-Doz. Dr. Christian F. Opitz
DRK Kliniken Berlin Köpenick, Klinik
für Innere Medizin, Schwerpunkt Kardiologie
Salvador-Allende-Straße
2–8
12559 Berlin
Telefon: 030/303533-18
Fax: 030/303533-21
eMail: c.opitz@drk-kliniken-berlin.de
