Skip to main content
SpringerLink
Log in

Kommentar zu den 2015 ESC/ERS-Leitlinien zur Diagnostik und Therapie der pulmonalen Hypertonie

Comment on the 2015 ESC/ERS guidelines on the diagnosis and treatment of pulmonary hypertension

  • Leitlinien
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die pulmonale Hypertonie (PH) ist ein häufiges Phänomen, das unabhängig von der zugrunde liegenden Ursache mit einer eingeschränkten Lebenserwartung einhergeht. Dank der Ergebnisse wegweisender Studien konnten in den letzten Jahren wesentliche Fortschritte in der Diagnostik und Therapie der PH, und insbesondere der pulmonal arteriellen Hypertonie (PAH), erzielt werden. Zahlreiche neue Daten wurden bei der Aktualisierung der gemeinsamen Leitlinien der European Society of Cardiology (ESC) und der European Respiratory Society (ERS) zur Diagnostik und Therapie der pulmonalen Hypertonie im Jahr 2015 berücksichtigt. Die aktualisierte Version beinhaltet wichtige Neuerungen hinsichtlich hämodynamischer Definitionen und der klinischen Klassifikation der PH. Darüber hinaus wurden die Empfehlungen und Algorithmen zum diagnostischen Vorgehen bei Verdacht auf PH sowie zur Risikostratifizierung und Therapie der PAH grundlegend überarbeitet, unter Berücksichtigung neuer Medikamente und der Etablierung effizienter Therapiekonzepte wie der Kombinationstherapie. Schließlich beinhalten die neuen ESC/ERS-Leitlinien detaillierte Empfehlungen zum Management anderer PH-Formen wie der PH bei Linksherz- oder Lungenerkrankungen und der chronisch thromboembolischen pulmonalen Hypertonie und definieren Kriterien für spezialisierte Expertenzentren. Dieser Kommentar fokussiert auf bedeutsame Änderungen gegenüber der vorpublizierten Version der ESC/ERS-Leitlinien zur PH aus dem Jahre 2009 und auf die praktische Implementierung der neuen Leitlinien in Deutschland.

Abstract

Pulmonary hypertension (PH) is a common phenomenon, which – independently from the underlying cause – is associated with a reduced life expectancy. Recently published landmark studies have led to substantial progress in the management of PH, particularly pulmonary arterial hypertension (PAH), and provided the basis for the updated recommendations of the 2015 joint guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) on the diagnosis and treatment of pulmonary hypertension. The updated version includes important modifications with regards to hemodynamic definitions and the clinical classification of PH. Furthermore, the recommendations and algorithms for the diagnostic assessment of patients with suspected PH, risk stratification and treatment of PAH were profoundly modified, introducing novel drugs and the establishment of improved treatment strategies, such as combination therapy. Finally, the new ESC/ERS guidelines provide formal recommendations for the management of other forms of PH, such as PH due to left heart or chronic lung disease and chronic thromboembolic pulmonary hypertension, and define criteria for specialized PH expert centres. This comment focusses on the most important changes compared to the previous version of the ESC/ERS guidelines published in 2009 and on the practical implementation of the new guidelines in Germany.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Badano PL, Barberà AJ, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol Ç, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Völler H, Zamorano LJ (2015) ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016(37):67–119

    Google Scholar 

  2. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Badano PL, Barberà AJ, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol Ç, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Völler H, Zamorano LJ (2015) ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J 2015(46):903–975

    Article  Google Scholar 

  3. Galiè N, Simonneau G (2013) The fifth world symposium on pulmonary hypertension. J Am Coll Cardiol 62:D1–D3

    Article  PubMed  Google Scholar 

  4. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30:2493–2537

    Article  PubMed  Google Scholar 

  5. Hoeper M, Bogaard HJ, Condliffe R et al (2013) Definition and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62(Suppl D):D42–D50

    Article  PubMed  Google Scholar 

  6. Vachiery JL, Adir Y, Barbera JA et al (2013) Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol 62(Suppl D):D100–D108

    Article  PubMed  Google Scholar 

  7. Rosenkranz S, Gibbs JSR, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiéry JL (2015) Left ventricular heart failure and pulmonary hypertension. Eur Heart J 37(12):942–954

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tunariu N, Gibbs SJ, Win Z et al (2007) Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 48:680–684

    Article  PubMed  Google Scholar 

  9. Hoeper MM, Lee SH, Voswinckel R et al (2006) Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol 48:2546–2552

    Article  PubMed  Google Scholar 

  10. Rosenkranz S, Behr J, Ewert R, Ghofrani HA, Grünig E, Halank M, Hoeper MM, Leuchte HH, Olschewski H, Schmeisser A, Speich R, Wilkens H, Opitz CF (2011) Rechtherzkatheter-Untersuchung bei pulmonaler Hypertonie. Dtsch Med Wochenschr 136:2601–2620

    Article  CAS  PubMed  Google Scholar 

  11. Jing ZC, Jiang X, Han ZY et al (2009) Iloprost for pulmonary vasodilator testing in idiopathic pulmonary arterial hypertension. Eur Respir J 33:1354–1360

    Article  CAS  PubMed  Google Scholar 

  12. Sitbon O, Humbert M, Jais X et al (2005) Long-term response to calcium channel blockers in idiopathic pulmonary arterial hypertension. Circulation 111:3105–3111

    Article  CAS  PubMed  Google Scholar 

  13. Galiè N, Corris PA, Frost A et al (2013) Updated treatment algorithm of pulmonary arterial hypertension. J Am Coll Cardiol 62(Suppl D):D60–D72

    Article  PubMed  Google Scholar 

  14. Olsson KM, Delcroix M, Ghofrani HA, Tiede H, Huscher D, Speich R, Grünig E, Staehler G, Rosenkranz S, Halank M, Held M, Lange TJ, Behr J, Klose H, Claussen M, Ewert R, Opitz CF, Vizza CD, Scelsi L, Vonk-Noordegraaf A, Kaemmerer H, Gibbs JS, Coghlan G, Pepke-Zaba J, Schulz U, Gorenflo M, Pittrow D, Hoeper MM (2014) Anticoagulation and survival in pulmonary arterial hypertension: Results from the COMPERA registry. Circulation 129:57–65

    Article  CAS  PubMed  Google Scholar 

  15. Preston RJ, Roberts KE, Miller DP, Hill NS, Farber HW (2014) Effect of warfarin treatment on survival of patients with pulmonary arterial hypertension (PAH) in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL). Am J Respir Crit Care Med 189:A2464

    Google Scholar 

  16. Pulido T, Adzerikho I, Channick RN et al (2013) Macitentan and morbidity and mortality in pulmonary arterial hypertension. New Engl J Med 369:809–818 (for the SERAPHIN Investigators)

    Article  CAS  PubMed  Google Scholar 

  17. Ghofrani HA, Galiè N, Grimminger F et al (2013) Riociguat for the treatment of pulmonary arterial hypertension. N Engl J Med 369:330–340 (for the PATENT Investigators)

    Article  CAS  PubMed  Google Scholar 

  18. Sitbon O, Channick R, Chin KM, Frey A, Gaine S, Galiè N, Ghofrani HA, Hoeper MM, Lang IM, Preiss R, Rubin LJ, Di Scala L, Tapson V, Adzerikho I, Liu J, Moiseeva O, Zeng X, Simonneau G, McLaughlin VV, GRIPHON Investigators (2015) Selexipag for the treatment of pulmonary arterial hypertension. N Engl J Med 373:2522–2533

    Article  PubMed  Google Scholar 

  19. Galiè N, Müller K, Scalise AV, Grünig E (2015) PATENT PLUS: a blinded, randomised and extension study of riociguat plus sildenafil in pulmonary arterial hypertension. Eur Respir J 45:1314–1322

    Article  PubMed  Google Scholar 

  20. Galiè N, Barbera JA, Frost A, Ghofrani A, Hoeper M, Mc Laughlin VV, Peacock A, Simonneau G, Vachiery JL, Grunig E, Oudiz RG, Vonk-Nordegraaf A, White J, Blair C, Gillies HC, Miller L, Harris JHN, Langley J, Rubin LJ (2015) Initial use of Ambrisentan plus Tadalafil in pulmonary arterial hypertension. N Engl J Med 379:834–844

    Article  Google Scholar 

  21. Seeger W, Adir Y, Barbera JA et al (2013) Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol 62(Suppl D):D109–D116

    Article  PubMed  Google Scholar 

  22. Boerrigter BG, Bogaard HJ, Trip P et al (2012) Ventilatory and cardiocirculatory exercise profiles in COPD: the role of pulmonary hypertension. Chest 142:1166–1174

    Article  PubMed  Google Scholar 

  23. Kim NH, Delcroix M, Jenkins DP et al (2013) Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 62(Suppl D):D92–D99

    Article  PubMed  Google Scholar 

  24. Mayer E, Jenkins D, Lindner J et al (2011) Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg 141:702–710

    Article  PubMed  Google Scholar 

  25. Madani MM, Auger WR, Pretorius V et al (2012) Pulmonary endarterectomy: Recent changes in a single institution’s experience of more than 2,700 patients. Ann Thorac Surg 94:97–103

    Article  PubMed  Google Scholar 

  26. Ghofrani HA, D’Armini AM, Grimminger F et al (2013) Riociguat for the treatment of chronic thromboembolic pulmonary hypertension. N Engl J Med 369:319–329 (for the CHEST Investigators)

    Article  CAS  PubMed  Google Scholar 

  27. Sugimura K, Fukumoto Y, Satoh K et al (2012) Percutaneous transluminal pulmonary angioplasty markedly improves pulmonary hemodynamics and long-term prognosis in patients with chronic thromboembolic pulmonary hypertension. Circ J 76:485–488

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50935, Köln, Deutschland

    S. Rosenkranz & S. Baldus

  2. Zentrum für pulmonale Hypertonie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    E. Grünig

  3. Abt. für Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    H. Klose

  4. Klinik für Innere Medizin Schwerpunkt Kardiologie, DRK-Kliniken Berlin Westend, Berlin, Deutschland

    C. Opitz

  5. Klinik für Pneumologie und Deutsches Zentrum für Lungenforschung (DZL), Medizinische Hochschule Hannover, Hannover, Deutschland

    M. M. Hoeper

Authors
  1. S. Rosenkranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Baldus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Grünig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Klose
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Opitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. M. Hoeper
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Rosenkranz.

Ethics declarations

Interessenkonflikt

Den Interessenkonflikt der Autoren S. Rosenkranz, S. Baldus, E. Grünig, H. Klose, C. Opitz und M. M. Hoeper finden Sie online auf der DGK-Homepage unter http://leitlinien.dgk.org/ bei der entsprechenden Publikation.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Stephan Baldus (Köln) für die Kommission für Klinische Kardiologie der DGK.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosenkranz, S., Baldus, S., Grünig, E. et al. Kommentar zu den 2015 ESC/ERS-Leitlinien zur Diagnostik und Therapie der pulmonalen Hypertonie. Kardiologe 10, 211–221 (2016). https://doi.org/10.1007/s12181-016-0068-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-016-0068-2

Schlüsselwörter

Keywords

Search

Navigation