Pulmonary hypertension (PH) is a clinical–physiological syndrome thought to affect 1% of the global population.1 PH is defined haemodynamically by mean pulmonary artery pressure >20 mm Hg, resulting in right ventricular (RV) overload and often RV failure. Patients with PH experience symptoms including dyspnoea, fatigue and oedema, often associated with physical and psychosocial disability. In some forms of untreated PH, mean survival is less than 3 years, related in part to delays in diagnosis of 1–2 years after clinical onset of disease. Diagnostic delays are due to non-specific symptoms, subtle clinical examination findings and low sensitivity of detection of PH features on imaging, ECG and pulmonary function testing. Indeed, patients are still most often diagnosed at an advanced stage, typically in New York Heart Association (NYHA) functional class 3. Guidelines recommend screening high-risk patients, such as those with scleroderma, with transthoracic echocardiogram looking for elevated pulmonary pressures or secondary features of PH, such as right-sided structural or functional abnormalities. PH is most commonly due to underlying diseases of the left side of the heart (WHO group 2 PH) and respiratory conditions characterised by hypoxaemia (WHO group 3 PH), cumulatively comprising about 90% of PH cases globally. WHO group 1 pulmonary arterial hypertension (PAH) and group 4 PH due to pulmonary arterial obstruction are uncommon, each being diagnosed in less than 5% of all patients with PH. However, they are a major focus of clinical PH diagnostic assessment as there are specific treatment approaches for patients in both groups. In WHO group 4, the most common and important condition chronic thromboembolic PH (CTEPH) is often curable; thus, all patients with significant PH should be rigorously assessed for possible CTEPH through pulmonary vascular imaging. WHO group 1 PAH is a disease specifically of the pulmonary circulation, sometimes related to underlying conditions and exposures (eg, connective …

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人工智能改善肺动脉高压的诊断：前景与陷阱

肺动脉高压 (PH) 是一种临床生理综合征，被认为影响全球 1% 的人口。1 肺动脉高压在血流动力学上定义为平均肺动脉压 >20 mm Hg，导致右心室 (RV) 超负荷并经常导致 RV 衰竭。 PH 患者会出现呼吸困难、疲劳和水肿等症状，这些症状通常与身体和心理残疾有关。在某些未经治疗的 PH 中，平均生存期不到 3 年，部分原因是临床发病后 1-2 年才诊断延迟。诊断延迟是由于非特异性症状、微妙的临床检查结果以及影像学、心电图和肺功能测试中 PH 特征检测的敏感性较低。事实上，患者通常仍处于晚期诊断，通常处于纽约心脏协会 (NYHA) 功能分级 3 级。指南建议筛查高危患者，例如患有硬皮病的患者，通过经胸超声心动图寻找肺压升高或继发性肺动脉高压。 PH 的特征，例如右侧结构或功能异常。 PH 最常见的原因是左侧心脏的基础疾病（WHO 2 类 PH）和以低氧血症为特征的呼吸系统疾病（WHO 3 类 PH），累计约占全球 PH 病例的 90%。由肺动脉阻塞引起的 WHO 第 1 组肺动脉高压 (PAH) 和第 4 组 PH 并不常见，在所有 PH 患者中，每种疾病的诊断率均低于 5%。然而，它们是临床 PH 诊断评估的主要焦点，因为两组患者都有特定的治疗方法。在 WHO 第 4 组中，最常见和最重要的慢性血栓栓塞性 PH (CTEPH) 通常是可以治愈的；因此，所有具有显着 PH 的患者都应通过肺血管成像严格评估可能的 CTEPH。世界卫生组织第 1 类 PAH 是一种专门针对肺循环的疾病，有时与潜在疾病和暴露有关（例如，结缔...