Статья посвящена возможностям успешного лечения пациентов с хронической тромбоэмболической легочной гипертензией (ХТЭЛГ). Рассматриваются основные проблемы ведения пациентов на различных этапах диагностики и лечения, вопросы распространенности и патогенеза ХТЭЛГ. Оцениваются ближайшие и отдаленные исходы после проведенного лечения. Цель исследования – представить современные возможности успешного лечения пациентов с ХТЭЛГ.
The article addresses therapies for chronic thromboembolic pulmonary hypertension (CTEPH). The main challenges of patient management at various stages of diagnosis and treatment and the prevalence and pathogenesis of CTEPH are described. Immediate and long-term outcomes after treatment are evaluated. The study aims to present current therapies for CTEPH.
1. Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation.
2011;124(18):1973-81. DOI:10.1161/CIRCULATIONAHA.110.015008
2. Чазова И.Е., Мартынюк Т.В., Акчурин Р.С., и др. Клинические рекомендации по диагностике и лечению хронической тромбоэмболической легочной гипертензии (I часть). Терапевтический архив. 2016;88(9):90-101 [Chazova IE, Martynyuk TV. Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (Part 1). Terapevticheskii Arkhiv (Ter. Arkh.). 2016;88(9):90-101 (in Russian)]. DOI:10.17116/terarkh201688990-101.
3. Simonneau G, Galiè N, Rubin LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2004;43(Suppl. 12):5-12. DOI:10.1016/j.jacc.2004.02.037
4. Чазова И.Е., Мартынюк Т.В., Валиева З.С., и др. Евразийские рекомендации по диагностике и лечению хронической тромбоэмболической легочной гипертензии (2020). Евразийский кардиологический журнал. 2021;(1):6-43 [Chazova IE, Martynyuk TV, Valieva ZS, et al. Eurasian Association of Cardiology (EAC) Guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (2020). Eur Heart J. 2021;(1):6-43 (in Russian)]. DOI:10.38109/2225-1685-2021-1-6-43
5. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-731. DOI:10.1093/eurheartj/ehac237
6. Wilkens H, Konstantinides S, Lang IM, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol. 2018;272S:69-78. DOI:10.1016/j.ijcard.2018.08.079
7. Giordano NJ, Jansson PS, Young MN, et al. Epidemiology, pathophysiology, stratification, and natural history of pulmonary embolism. Tech Vasc Interv Radiol. 2017;20(3):135-40. DOI:10.1053/j.tvir.2017.07.002
8. Simonneau G, Torbicki A, Dorfmüller P, Kim N. The pathophysiology of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26(143):160112. DOI:10.1183/16000617.0112-2016
9. Zhang M, Wang N, Zhai Z, et al. Incidence and risk factors of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a systematic review and meta-analysis of cohort studies. J Thorac Dis. 2018;10(8):4751-63. DOI:10.21037/jtd.2018.07.106
10. Pengo V, Lensing AWA, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257-64. DOI:10.1056/nejmoa032274
11. Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006;130(1):172-5. DOI:10.1378/chest.130.1.172
12. Ende-Verhaar YM, Cannegieter SC, Noordegraaf AV, et al. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature. Eur Respir J. 2017;49(2):1601792. DOI:10.1183/13993003.01792-2016
13. Escribano-Subias P, Blanco I, López-Meseguer M, et al. Survival in pulmonary hypertension in Spain: insights from the Spanish registry. Eur Respir J. 2012;40(3):596-603. DOI:10.1183/09031936.00101211
14. Condliffe R, Kiely DG, Gibbs JSR, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008;177(10):1122-7. DOI:10.1164/rccm.200712-1841OC
15. Madani MM. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: state-of-the-art 2020. Pulm Circ. 2021;11(2):20458940211007372. DOI:10.1177/20458940211007372
16. Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2019;53(1):1801915. DOI:10.1183/13993003.01915-2018
17. Васильцева О.Я., Едемский А.Г., Гранкин Д.С., и др. Путь от тромбоэмболии легочной артерии к хронической тромбоэмболической легочной гипертензии: факторы риска. Патология кровообращения и кардиохирургия. 2021;25(3):11-9 [Kliver EN, Edemskiy AG, Grankin DS, et al. From pulmonary embolism to chronic thromboembolic pulmonary hypertension: risk factors. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2021;25(3):11-9 (in Russian)].
DOI:10.21688/1681-3472-2021-3-11-19
18. Madani MM, Auger WR, Pretorius V, et al. Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2,700 patients. Ann Thorac Surg.
2012;94(1):97-103. DOI:10.1016/j.athoracsur.2012.04.004
19. Cannon JE, Su L, Kiely DG, et al. Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort. Circulation. 2016;133(8):1761-71. DOI:10.1161/CIRCULATIONAHA.115.019470
20. Brookes JDL, Li C, Chung STW, et al. Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review. Ann Cardiothorac Surg. 2022;11(2):68-81. DOI:10.21037/acs-2021-pte-25
21. Martin-Suarez S, Loforte A, Cavalli GG, et al. Therapeutic alternatives in chronic thromboembolic pulmonary hypertension: from pulmonary endarterectomy to balloon pulmonary angioplasty to medical therapy. State of the art from a multidisciplinary team. Ann Cardiothorac Surg. 2022;11(2):120-7. DOI:10.21037/acs-2021-pte-23
22. Чернявский А.М., Едемский А.Г., Новикова Н.В., и др. Хирургическое лечение хронической тромбоэмболической легочной гипертензии. Новосибирск: СО РАН, 2019 [Cherniavskii AM, Edemskii AG, Novikova NV, et al. Khirurgicheskoe lechenie khronicheskoi tromboembolicheskoi legochnoi gipertenzii. Novosibirsk: SO RAN, 2019 (in Russian)].
23. Едемский А.Г., Иванов С.Н., Кливер Е.Н., и др. Путь пациента от острой тромбоэмболии легочной артерии до хронической тромбоэмболической легочной гипертензии: вопросы диагностики и лечения. Терапевтический архив. 2019;91(8):108-14 [Edemskiy AG, Ivanov SN, Kliver EN, et al. Patient's way from acute pulmonary embolism to сhronic thromboembolic pulmonary hypertension: diagnostic and treatment options. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(8):108-14 (in Russian)]. DOI:10.26442/00403660.2019.08.000316
24. Васильцева О.Я., Ворожцова И.Н., Силиванова И.Х., и др. К вопросу о маршрутизации пациентов с тромбоэмболией легочной артерии. Кардиоваскулярная терапия и профилактика. 2016;15(6):72-7 [Vasiltseva OYa, Vorozhtsova IN, Selivanova IKh, et al. An issue of the patients routing in case of pulmonary embolism. Cardiovascular Therapy and Prevention. 2016;15(6):72-7 (in Russian)]. DOI:10.15829/1728-8800-2016-6-72-77
25. Konstantinides SV. Detection and treatment of chronic thromboembolic pulmonary hypertension: still a lot of homework to do. Hellenic J Cardiol. 2018;59(1):24-5. DOI:10.1016/j.hjc.2018.02.012
26. Kramm T, Wilkens H, Fuge J, et al. Incidence and characteristics of chronic thromboembolic pulmonary hypertension in Germany. Clin Res Cardiol. 2018;107(7):548-53. DOI:10.1007/s00392-018-1215-5
27. Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008;177(10):1122-27. DOI:10.1164/rccm.20071 2-1841O C
28. Escribano-Subias P, Blanco I, Lopez-Meseguer M, et al. Survival in pulmonary hypertension in Spain: insights from the Spanish registry. Eur Respir J. 2012;40(3):596-603. DOI:10.1183/09031 936.00101211
29. López Gude MJ, Pérez de la Sota E, Pérez Vela JL, et al. Pulmonary endarterectomy outputs in chronic thromboembolic pulmonary hypertension. Med Clin (Barc). 2017;149(1):1-8. DOI:10.1016/j.medcli.2016.12.032
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1. Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation.
2011;124(18):1973-81. DOI:10.1161/CIRCULATIONAHA.110.015008
2. Chazova IE, Martynyuk TV. Clinical guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (Part 1). Terapevticheskii Arkhiv (Ter. Arkh.). 2016;88(9):90-101 (in Russian). DOI:10.17116/terarkh201688990-101.
3. Simonneau G, Galiè N, Rubin LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2004;43(Suppl. 12):5-12. DOI:10.1016/j.jacc.2004.02.037
4. Chazova IE, Martynyuk TV, Valieva ZS, et al. Eurasian Association of Cardiology (EAC) Guidelines for the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (2020). Eur Heart J. 2021;(1):6-43 (in Russian). DOI:10.38109/2225-1685-2021-1-6-43
5. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-731. DOI:10.1093/eurheartj/ehac237
6. Wilkens H, Konstantinides S, Lang IM, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): updated recommendations from the Cologne Consensus Conference 2018. Int J Cardiol. 2018;272S:69-78. DOI:10.1016/j.ijcard.2018.08.079
7. Giordano NJ, Jansson PS, Young MN, et al. Epidemiology, pathophysiology, stratification, and natural history of pulmonary embolism. Tech Vasc Interv Radiol. 2017;20(3):135-40. DOI:10.1053/j.tvir.2017.07.002
8. Simonneau G, Torbicki A, Dorfmüller P, Kim N. The pathophysiology of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017;26(143):160112. DOI:10.1183/16000617.0112-2016
9. Zhang M, Wang N, Zhai Z, et al. Incidence and risk factors of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a systematic review and meta-analysis of cohort studies. J Thorac Dis. 2018;10(8):4751-63. DOI:10.21037/jtd.2018.07.106
10. Pengo V, Lensing AWA, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257-64. DOI:10.1056/nejmoa032274
11. Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006;130(1):172-5. DOI:10.1378/chest.130.1.172
12. Ende-Verhaar YM, Cannegieter SC, Noordegraaf AV, et al. Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature. Eur Respir J. 2017;49(2):1601792. DOI:10.1183/13993003.01792-2016
13. Escribano-Subias P, Blanco I, López-Meseguer M, et al. Survival in pulmonary hypertension in Spain: insights from the Spanish registry. Eur Respir J. 2012;40(3):596-603. DOI:10.1183/09031936.00101211
14. Condliffe R, Kiely DG, Gibbs JSR, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008;177(10):1122-7. DOI:10.1164/rccm.200712-1841OC
15. Madani MM. Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: state-of-the-art 2020. Pulm Circ. 2021;11(2):20458940211007372. DOI:10.1177/20458940211007372
16. Kim NH, Delcroix M, Jais X, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2019;53(1):1801915. DOI:10.1183/13993003.01915-2018
17. Kliver EN, Edemskiy AG, Grankin DS, et al. From pulmonary embolism to chronic thromboembolic pulmonary hypertension: risk factors. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2021;25(3):11-9 (in Russian). DOI:10.21688/1681-3472-2021-3-11-19
18. Madani MM, Auger WR, Pretorius V, et al. Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2,700 patients. Ann Thorac Surg.
2012;94(1):97-103. DOI:10.1016/j.athoracsur.2012.04.004
19. Cannon JE, Su L, Kiely DG, et al. Dynamic Risk Stratification of Patient Long-Term Outcome After Pulmonary Endarterectomy: Results From the United Kingdom National Cohort. Circulation. 2016;133(8):1761-71. DOI:10.1161/CIRCULATIONAHA.115.019470
20. Brookes JDL, Li C, Chung STW, et al. Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review. Ann Cardiothorac Surg. 2022;11(2):68-81. DOI:10.21037/acs-2021-pte-25
21. Martin-Suarez S, Loforte A, Cavalli GG, et al. Therapeutic alternatives in chronic thromboembolic pulmonary hypertension: from pulmonary endarterectomy to balloon pulmonary angioplasty to medical therapy. State of the art from a multidisciplinary team. Ann Cardiothorac Surg. 2022;11(2):120-7. DOI:10.21037/acs-2021-pte-23
22. Cherniavskii AM, Edemskii AG, Novikova NV, et al. Khirurgicheskoe lechenie khronicheskoi tromboembolicheskoi legochnoi gipertenzii. Novosibirsk: SO RAN, 2019 (in Russian).
23. Edemskiy AG, Ivanov SN, Kliver EN, et al. Patient's way from acute pulmonary embolism to сhronic thromboembolic pulmonary hypertension: diagnostic and treatment options. Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(8):108-14 (in Russian). DOI:10.26442/00403660.2019.08.000316
24. Vasiltseva OYa, Vorozhtsova IN, Selivanova IKh, et al. An issue of the patients routing in case of pulmonary embolism. Cardiovascular Therapy and Prevention. 2016;15(6):72-7 (in Russian). DOI:10.15829/1728-8800-2016-6-72-77
25. Konstantinides SV. Detection and treatment of chronic thromboembolic pulmonary hypertension: still a lot of homework to do. Hellenic J Cardiol. 2018;59(1):24-5. DOI:10.1016/j.hjc.2018.02.012
26. Kramm T, Wilkens H, Fuge J, et al. Incidence and characteristics of chronic thromboembolic pulmonary hypertension in Germany. Clin Res Cardiol. 2018;107(7):548-53. DOI:10.1007/s00392-018-1215-5
27. Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008;177(10):1122-27. DOI:10.1164/rccm.20071 2-1841O C
28. Escribano-Subias P, Blanco I, Lopez-Meseguer M, et al. Survival in pulmonary hypertension in Spain: insights from the Spanish registry. Eur Respir J. 2012;40(3):596-603. DOI:10.1183/09031 936.00101211
29. López Gude MJ, Pérez de la Sota E, Pérez Vela JL, et al. Pulmonary endarterectomy outputs in chronic thromboembolic pulmonary hypertension. Med Clin (Barc). 2017;149(1):1-8. DOI:10.1016/j.medcli.2016.12.032
ФГБУ «Национальный медицинский исследовательский центр им. акад. Е.Н. Мешалкина» Минздрава России, Новосибирск, Россия
*devranzeynalov@mail.ru
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Oksana Ya. Vasiltseva, Alexander G. Edemskiy, Devran F. Zeinalov*, Elena N. Kliver, Wladimir Yu. Ussov, Denis S. Grankin, Dmitry A. Sirota, Aleksandr M. Chernyavskiy