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Pulmonary hypertension associated with left-sided heart failure
Joana Adler1, Felix Gerhardt1, Max Wissmüller1
1Clinic III for Internal Medicine, Heart Center at the University of Cologne.
Current Opinion in Cardiology
|September 24, 2020
Summary
Pulmonary hypertension in heart failure is complex. Recent findings clarify definitions and management strategies for isolated postcapillary (IpcPH) and combined post and precapillary pulmonary hypertension (CpcPH), improving patient outcomes.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Heart Failure Research
Background:
- Pulmonary hypertension (PH) is prevalent in heart failure (HF) patients, significantly impacting morbidity and outcomes.
- The pathophysiology of PH in HF with reduced or preserved ejection fraction is complex, complicating management decisions.
Purpose of the Study:
- To critically review recent developments in the understanding and management of PH in left-sided heart failure (LHF).
- To highlight distinct treatment strategies targeting the left heart condition, pulmonary circulation, and right ventricular function.
Main Methods:
- Review of recent hemodynamic definitions and subclassification of postcapillary pulmonary hypertension (PH).
- Analysis of novel data on the prognostic impact of hemodynamic variables and right ventricular function.
- Investigation of management strategies including medical therapy, remote hemodynamic monitoring, and interventional approaches.
Main Results:
- Revisited hemodynamic definitions distinguish isolated postcapillary PH (IpcPH) from combined post and precapillary PH (CpcPH).
- Cardiopulmonary interaction is crucial in LHF, with hemodynamic variables and right ventricular function impacting prognosis.
- Management strategies show impact on hemodynamics and outcomes.
Conclusions:
- Detailed hemodynamic characterization and phenotyping are essential for prognostication and management of PH associated with LHF.
- Understanding the nuances between IpcPH and CpcPH guides therapeutic decisions.
- Tailored treatment strategies are key for improving outcomes in these complex patients.
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