Left ventricular heart failure and pulmonary hypertension.

Area of Science:

• Cardiology
• Pulmonology
• Heart Failure Research

Background:

• Pulmonary hypertension (PH) and right ventricular (RV) dysfunction frequently complicate left ventricular heart failure (HF), significantly impacting prognosis.
• Pulmonary hypertension related to left heart disease (LHD) is the most common type of PH, comprising 65-80% of cases.
• Distinguishing PH-LHD from pulmonary arterial hypertension is clinically important due to differing therapeutic implications.

Purpose of the Study:

• To highlight the prevalence and significance of PH and RV dysfunction in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
• To provide insights into the complex pathophysiology of cardiopulmonary interactions in LHD.
• To propose an integrated approach for defining individual PH phenotypes in LHD.

Main Methods:

• Review of current literature on PH and RV dysfunction in HF.
• Analysis of pathophysiological mechanisms linking LHD to PH and RV dysfunction.
• Discussion of diagnostic strategies integrating clinical context, non-invasive, and invasive hemodynamic data.

Main Results:

• PH and RV dysfunction are highly prevalent in LHD across the spectrum of HF.
• The pathophysiology involves complex cardiopulmonary interactions, potentially leading to a 'right ventricular phenotype' in HF progression.
• Current definitions and diagnostic criteria for PH-LHD are suboptimal, with limited evidence-based management recommendations.

Conclusions:

• A structured diagnostic work-up integrating multiple data sources is needed to better phenotype PH in LHD.
• There are significant gaps in evidence regarding the management of PH-LHD.
• Future research and therapeutic developments are necessary to address the challenges in PH-LHD.