Pulmonale Hypertonie bei Linksherzerkrankungen: Empfehlungen der Kölner Konsensus-Konferenz 2016

Zusammenfassung

Die 2015 veröffentlichen Europäischen Leitlinien zur Diagnostik und Therapie der pulmonalen Hypertonie (PH) sind nunmehr auch in Deutschland gültig. Während sich die Leitlinien eingehend mit der pulmonal arteriellen Hypertonie (PAH) befassen, wird die häufig vorkommende PH infolge von Linksherzerkrankungen nur relativ kurz behandelt. Aktuell lässt sich in zunehmendem Maße ein unkritischer Einsatz gezielter PAH-Medikamente bei Patienten mit PH infolge von Linksherzerkrankungen beobachten, obwohl keine entsprechenden Wirksamkeitsdaten vorliegen. Diese Entwicklung gibt Anlass zur Sorge, zumal Ressourcen limitiert sind und eine evidenzbasierte Medizin Basis unseres Handles sein muss. Andererseits ist die PH bei Patienten mit Linksherzinsuffizienz ein häufiges Problem welches für die Morbidität und Prognose der Patienten bedeutsam ist, so dass sich bei ausgewählten Patienten die Frage nach einer gezielten Behandlung der PH stellt. Diesbezüglich sind für die praktische Umsetzung der Europäischen Leitlinien in Deutschland zahlreiche spezifische Gesichtspunkte und bereits wieder neue Daten bedeutsam, die eine ausführliche Kommentierung der Leitlinien und in einigen Punkten eine Aktualisierung notwendig machen. Im Juni 2016 fand in Köln eine Konsensus-Konferenz statt, die von den Arbeitsgruppen PH der Deutschen Gesellschaften für Kardiologie (DGK), Pneumologie (DGP) und Pädiatrische Kardiologie (DGPK) organisiert wurde. Die Konferenz befasste sich mit der Umsetzung der Europäischen Leitlinien in Deutschland. Dazu wurden verschiedene Arbeitsgruppen eingesetzt, von denen sich eine gezielt der PH bei Linksherzerkrankungen widmete. Die Ergebnisse und Empfehlungen dieser Arbeitsgruppe werden in dem vorliegenden Manuskript detailliert beschrieben.

Abstract

The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more common forms of PH such as PH due to left heart disease. Despite the lack of data, targeted PAH treatments are increasingly being used for PH associated with left heart disease. This development is of concern because of limited ressources and the need to base treatments on scientific evidence. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease, representing an unmet need of targeted PH therapies. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, several working groups were initiated, one of which was specifically dedicated to PH associated with left heart disease. This article summarizes the results and recommendations of this working group.

Schlüsselwörter

Pulmonale Hypertonie - Linksherzerkrankung - Herzinsuffizienz - Klappenvitium - Therapie

Keywords

pulmonary hypertension - left heart disease - heart failure - valvular heart disease - therapy

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