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Screening auf pulmonale Hypertonie

Screening in pulmonary hypertension

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  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die pulmonal arterielle Hypertonie (PAH) ist eine seltene Erkrankung, bei welcher ein generelles bevölkerungsbasiertes Screening wegen der geringen Prävalenz und fehlender einfacher Suchtests nicht empfohlen wird. Dennoch sollte bei Patienten mit Belastungsdyspnoe, welche das häufigste Symptom einer PAH ist, neben den häufigen Ursachen der Atemnot (Herz- bzw. Lungenerkrankungen, Anämie) auch an die pulmonale Hypertonie (PH) gedacht werden. Die wichtigste nichtinvasive Untersuchungsmethode ist die auf PH fokussierte Echokardiographie. Wichtige Hinweise können auch einfache Methoden geben, wie ein Rechtstyp im EKG, die rechtsseitige Verbreiterung des Herzens im Thorax-Röntgenbild oder die Erhöhung des Brain Natriuretic Peptide (BNP) bzw. des N‑terminal Pro Brain Natriuretic Peptide (NT-proBNP). Bei unklarer Symptomatik ist die Spiroergometrie sehr hilfreich. Spezialisierte Computertomographie-(CT-) und Magnetresonanztomographie (MRT-)Methoden erlauben die nichtinvasive Erfassung der pulmonalen Hämodynamik. Besonders wichtig ist es, bei Risikoerkrankungen einer PAH gezielte Untersuchungen durchzuführen. Bei der Sklerodermie wird ein regelmäßiges Screening mittels Echokardiographie empfohlen, auch wenn keine Dyspnoe vorliegt. Bei angeborenen Herzfehlern, HIV-Infektion, portaler Hypertension oder nach einer akuten Lungenembolie wird bei chronischer Belastungsdyspnoe ein aktives Screening auf PH empfohlen. Bei schweren Lungenerkrankungen soll eine Überweisung ins Expertenzentrum erfolgen, wenn sich in der Echokardiographie Hinweise auf eine schwere PH ergeben.

Abstract

Pulmonary arterial hypertension (PAH) is a rare disease and due to its low prevalence and lack of simple specific diagnostic tests, general screening is not recommended. Nevertheless, in patients with chronic exertional dyspnea, which is the main symptom of PAH, in addition to the frequent causes of dyspnea, such as left heart and lung diseases or anemia, pulmonary hypertension (PH) should also be considered. The most important non-invasive diagnostic examination method is echocardiography with the focus on PH. Furthermore, simple tools, such as right axis deviation in the electrocardiogram (ECG), right-sided cardiomegaly in chest X‑rays and increased brain natriuretic peptide (BNP) or N‑terminal pro brain natriuretic peptide (NT-proBNP) levels, may reveal important signs of PH. Cardiopulmonary exercise testing may add important diagnostic information in cases of unclear symptoms. Specialized computed tomography (CT) and magnetic resonance imaging (MRI) methods enable the non-invasive assessment of pulmonary hemodynamics. It is especially important to perform targeted investigations in patients at risk for PAH. In patients with systemic sclerosis annual screening with echocardiography is recommended even in asymptomatic patients. In patients with congenital heart disease, HIV infections, portal hypertension or after pulmonary embolism and additional exertion dyspnea, an active screening for PH is recommended. Patients with severe lung diseases and echocardiographic signs of severe PH should be referred to a PH expert center.

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  1. Universitätsklinik für Innere Medizin, Abteilung für Lungenkrankheiten, Medizinische Universität Graz, Auenbruggerplatz 20, 8036, Graz, Österreich

    G. Kovacs &  H. Olschewski

  2. Ludwig Boltzmann Institut für Lungengefäßforschung, Graz, Österreich

    G. Kovacs &  H. Olschewski

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Kovacs, G., Olschewski, H. Screening auf pulmonale Hypertonie. Pneumologe 14, 153–159 (2017). https://doi.org/10.1007/s10405-017-0105-2

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