Abstract
Pulmonary hypertension (PH) is defined as increased mean pulmonary artery pressure (mPAP) above 25 mmHg, measured at rest by right heart catheterization. The exact global prevalence of PH is difficult to estimate, mainly due to the complex aetiology, and its spread may be underestimated. To date, numerous studies on the aetiology and pathophysiology of PH at molecular level were conducted. Simultaneously, some clinical studies have shown potential usefulness of well-known and widely recognized cardiovascular biomarkers, but their potential clinical usefulness in diagnosis and management of PH is poor due to their low specificity accompanied with numerous other cardiovascular comorbidities of PH subjects. On the other hand, a large body of basic research-based studies provides us with novel molecular pathomechanisms, biomarkers, and drug targets, according to the evidence-based medicine principles. Unfortunately, the simple implementation of these results to clinical practice is impossible due to a large heterogeneity of the PH pathophysiology, where the clinical symptoms constitute only a common denominator and a final result of numerous crosstalking metabolic pathways. Therefore, future studies, based mostly on translational medicine, are needed in order to both organize better the pathophysiological classification of various forms of PH and define precisely the optimal diagnostic markers and therapeutic targets in particular forms of PH. This review paper summarizes the current state of the art regarding the molecular background of PH with respect to its current classification. Novel therapeutic strategies and potential biomarkers are discussed with respect to their limitations in use in common clinical practice.
Highlights
Pulmonary hypertension (PH) is defined as increased mean pulmonary arterial pressure above 25 mmHg, measured at rest by right heart catheterization [1]
This review summarizes the state of the art regarding the knowledge on the pathomechanisms of PH
As long as we are not able to treat pulmonary hypertension successfully, studies were focused on identifying the new risk factors and risk assessment methods, so as to more accurately specify the group of patients requiring intensive supervision
Summary
Pulmonary hypertension (PH) is defined as increased mean pulmonary arterial pressure (mPAP) above 25 mmHg, measured at rest by right heart catheterization [1]. The exact global prevalence of the disease is difficult to estimate mainly due to the complex aetiology, and its spread may be significantly underestimated. Based on the hemodynamic parameters assessed during right heart catheterization (especially DPG (diastolic pressure gradient) and PVR (pulmonary vascular resistance)), PH was divided into pre- and postcapillary PH. The pathophysiological mechanisms leading to increased pressure in the pulmonary vessels are primarily connected with vascular remodelling. They can be caused by primary dysfunctions of endothelial cells (ECs) or smooth muscles accompanied by proliferative disorders, oxidative damage, abnormal angiogenesis, or capillary leak.
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