Pulmonary hypertension (PH) is a feared complication of interstitial lung disease (ILD) owing to increased risk for hospitalisation and mortality among affected patients. The development of PH in ILD is attributed to several pathobiological mechanisms that often converge to remodel pulmonary arterioles including hypoxic pulmonary vasoconstriction, endothelial dysfunction, inflammation, increased oxidant stress and the pathogenic effects of parenchymal fibrosis on the alveolar-capillary interface.1 The classical definition of precapillary PH used a mean pulmonary arterial pressure (mPAP) ≥25 mm Hg and pulmonary vascular resistance (PVR) ≥3 Wood units (WU), but these haemodynamic criteria were based largely on consensus opinion in the absence of normative data or information on the association between cardiopulmonary hemodynamics and outcomes. A retrospective meta-analysis involving data from healthy volunteers suggested that the upper limit of normal mPAP is ~20 mm Hg, which converged with findings in large referral cohorts suggesting that mPAP>20 mm Hg is common and associated with a substantial increase in mortality risk.2 3 Similarly, data on PVR suggest that values ≥2 WU are clinically important and have significant associations with mortality and hospitalisation for heart failure.4 These and other observations supported the recent revision to the haemodynamic criteria that defines precapillary PH as mPAP>20 mm Hg, PVR>2 WU, and pulmonary artery wedge pressure <15 mm Hg.5 6 Since most outcomes data are from unselected referral cohorts, there is an overarching …

中文翻译：

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PH-ILD 中肺血管阻力轻度升高和生存恶化：早期诊断和干预的机会？

肺动脉高压（PH）是间质性肺病（ILD）的一种令人担忧的并发症，因为受影响的患者住院和死亡的风险增加。 ILD 中 PH 的发生归因于多种病理生物学机制，这些机制通常会共同重塑肺小动脉，包括缺氧性肺血管收缩、内皮功能障碍、炎症、氧化应激增加以及实质纤维化对肺泡-毛细血管界面的致病作用。 1 经典定义毛细血管前 PH 使用平均肺动脉压 (mPAP) ≥25 mm Hg 和肺血管阻力 (PVR) ≥3 Wood 单位 (WU)，但这些血流动力学标准主要基于共识意见，缺乏规范数据或信息心肺血流动力学与结果之间的关联。一项涉及健康志愿者数据的回顾性荟萃分析表明，正常 mPAP 的上限约为 20 mm Hg，这与大型转诊队列中的发现结果一致，表明 mPAP > 20 mm Hg 很常见，并且与死亡风险大幅增加相关.2 3 同样，PVR 数据表明，≥2 WU 的值在临床上很重要，并且与死亡率和心力衰竭住院率显着相关。4 这些和其他观察结果支持最近对血流动力学标准的修订，该标准将毛细血管前 PH 定义为 mPAP>20毫米汞柱、PVR>2 WU 和肺动脉楔压 <15 毫米汞柱。5 6 由于大多数结果数据来自未经选择的转诊队列，因此存在一个总体的……