《国际循环》：肺循环领域在今年进展比较快，肺动脉高压的非侵入性评估、预后和随访、右室功能等都是一些热门话题，请您谈一下非侵入性评估策略以及右室功能衰竭、肺动脉高压治疗方面的进展。   

     <International Circulation>: Pulmonary circulation is a rapid progress area this year. Non-invasive evaluation， prognostic staging and follow-up of pulmonary hypertension， and right ventricular function are topics of interest. Could you tell us something about these topics - non-invasive evaluation methods and the management of right ventricular failure in pulmonary hypertension patients? 
 

    Torbicki教授：与预后有关的就目前来说，例如在急性肺栓塞，重要的事情是临床评估和功能分级，不论它是处在第一、第二或第三（这已经是很不好了）或第四级。为了应对最初的治疗，患者不能处在第三功能分级，另一方面，我们有大量的非常好的包括最新超声心动图的实验小组，例如三尖瓣收缩期环状移位，和其他的超声心动图指示相比，这很容易去测量。这是真正的可复现的，并且不需要很多的内部的或内在的可变的观察者 。对于评估心室功能，这看上去是一个好的且简单的指标。当然，这仍有其他的形式，例如通过几个好的预后指数的磁共振成像，但是对于一般的受到少量限制的医学群体来说这并不是容易的且有效的。那么这儿有生物标记，NT-proBNP，是到目前为止，这种疾病最广泛被使用且可靠的标记.另一方面，我们仍然不清楚使用它的最佳方法和最佳甄别阈值-或许大约在1400pg/ml这个水平，这看上去是一个安全的范围。如果病人的NT-proBNP低于这个值，那么他们看上去处在安全的一边。这仍然需要前瞻性的研究并且我们仍然需要继续学习。

    Prof. Torbicki: As far as prognosis is concerned， just as in acute pulmonary embolism， the most important thing is the clinical evaluation and the functional class – whether it is first， second， or third (which is already not good) or fourth. In response to initial treatment， the patient should not be in third functional class. Again we have a large panel of very good tests including new echocardiography， such as tricuspid annular systolic displacement which is very easy to measure in contrast to other echocardiographic indices. It is very reproducible and without too much inter- or intra-observer variability. It seems to be a good and easy index for evaluating ventricular function. Then there are other modalities such as magnetic resonance imaging with a couple of good prognostic indices but this is not so readily available to the general medical community which limits it a little. Then there are biomarkers. NT-proBNP is， by far， the most widely used and reliable marker of this disease. Again， we still don’t know the best way to use it and the best cut-off values – probably somewhere around 1400 pg/ml is a level that seems to be a safety margin. If the patient has NT-proBNP levels below this value， it seems that they are on the safe side. This still requires prospective studies and we are still learning.