systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2023-2-21-27systhiper-782Research ArticleОБЗОРREVIEWНовые диагностические критерии легочной артериальной гипертензии: за и противNew criteria for diagnosis of pulmonary arterial hypertension: pros and conshttps://orcid.org/0009-0009-6866-582XНиколаеваЕ. А.NikolaevaE. A.

Николаева Елена Алексеевна, врач-кардиолог отделения организации контроля качества оказания медицинской помощи и экспертизы временной нетрудоспособности

ул. академика Чазова, д. 15 А, г. Москва 121552

тел.: 8-495-414-65-42

Elena A. Nikolaeva, cardiologist of the Department of the organization of quality control of medical care and examination of temporary disability

Academician Chazova str. 15 a, Moscow 121552

enikolaeva1987@mail.ruhttps://orcid.org/0000-0002-9022-8097МартынюкТ. В.MartynyukT. V.

Мартынюк Тамила Витальевна, д.м.н., руководитель отдела легочной гипертензии и заболеваний сердца;  профессор кафедры кардиологии

ул. академика Чазова, д. 15 А, г. Москва 121552

ул. Островитянова, 1, стр. 7, г. Москва 117997

тел.: 8-495-414-64-50

Tamila V. Martynyuk, Dr. of Sci. (Med.), Head of the Department of pulmonary hypertension and heart disease; Professor, Department of Cardiology, Faculty of Continuing Professional Education

Academician Chazova str. 15 a, Moscow 121552

Ostrovitianov str. 1, Moscow 117997

trukhiniv@mail.ruНаучно-исследовательский институт клинической кардиологии имени А.Л. Мясникова, Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр кардиологии им. академика Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiologyRussian FederationНаучно-исследовательский институт клинической кардиологии имени А.Л. Мясникова, Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр кардиологии им. академика Е.И. Чазова» Минздрава России; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияA.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology; Pirogov Russian National Research Medical UniversityRussian Federation2023260620232022127Copyright © Николаева Е.А., Мартынюк Т.В., 20232023Николаева Е.А., Мартынюк Т.В.Nikolaeva E.A., Martynyuk T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/782

В обновленной версии рекомендаций по диагностике и лечению легочной гипертензии ESC/ERS 2022 утверждены новые диагностические критерии легочной гипертензии (ЛГ). В рамках данного обзора проводится анализ результатов современных исследований, доказывающих целесообразность изменения пороговых значений параметров гемодинамики для диагностики ЛГ при катетеризации правых отделов сердца (КПОС) и эхокардиографии (ЭхоКГ), важность введения в клиническую практику понятия «ЛГ при физической нагрузке».

Новые диагностические критерии легочной артериальной гипертензии: среднее давление в легочной артерии (срДЛА) > 20 мм рт. ст., давление заклинивания легочной артерии ≤ 15 мм рт. ст., легочное сосудистое сопротивление (ЛСС) > 2 ед. Вуда по данным КПОС в покое. Диагностические уровни расчетного систолического давления в легочной артерии и скорости трикуспидальной регургитации при ЭхоКГ остаются прежними, но с учетом дополнительных ЭхоКГ-признаков ЛГ.

В ранней диагностике ЛГ перспективным направлением является КПОС с физической нагрузкой в дополнение к исследованиям в покое. В настоящее время нет общепринятых диагностических критериев ЛГ при физической нагрузке. В отдельных исследованиях предложены следующие пороговые значения: повышение срДЛА > 30 мм рт. ст. и ЛСС > 3 единиц Вуда во время нагрузки.

The updated 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension approved new criteria for diagnosis of pulmonary hypertension (PH). In this review we present the data from modern studies proving the expediency of changing the threshold values of hemodynamic parameters measured by right heart catheterization (RHC) and echocardiography for the diagnosis of PH, the importance of introduction the definition «exercise PH» into clinical practice.

New haemodynamic definition of pulmonary arterial hypertension: mean pulmonary arterial pressure (mPAP) > 20 mmHg, pulmonary arterial wedge pressure < 15 mmHg, pulmonary vascular resistance (PVR) > 2 Wood units, measured by RHC at rest. Diagnostic levels of systolic pulmonary arterial pressure and tricuspid regurgitation velocity measured by echocardiography stay the same, but it is important to combine them with a number of additional echocardiographic signs of PH.

Promising direction for early diagnosis of PH is RHC during exercise in addition to studies at rest. Nowadays there are no generally accepted diagnostic criteria for exercise PH. Some studies propose the following threshold values of exercise PH: mPAP > 30 mmHg and PVR > 3 Wood units during exercise.

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The authors declare that there are no conflicts of interest present.