Pulmonary Hypertension in Heart Failure

Area of Science:

• Cardiology
• Pulmonology
• Heart Failure Research

Background:

• Pulmonary hypertension (PH) is defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg.
• The most common cause of PH is left heart disease (LHD), encompassing heart failure (HF), valvular disease, cardiomyopathies, and arrhythmias.
• Elevated left atrial pressure in LHD leads to pulmonary venous backflow, increasing mPAP, termed isolated postcapillary PH (IpcPH).

Purpose of the Study:

• To review the diagnosis, pathophysiology, and treatment of PH in heart failure (HF).
• To explore the progression of PH-LHD and potential therapeutic strategies.
• To evaluate the rationale for using pulmonary arterial hypertension (PAH)-specific drugs in combined precapillary and postcapillary PH (CpcPH).

Main Methods:

• Review of current literature on PH-LHD pathophysiology and treatment.
• Analysis of the progression from IpcPH to CpcPH.
• Evaluation of existing therapeutic approaches for PH-LHD in heart failure populations.

Main Results:

• PH-LHD progresses from IpcPH to CpcPH with pulmonary vasculature remodeling.
• PAH-specific drugs have shown limited efficacy in HFrEF and HFpEF.
• CpcPH presents a more promising target for PAH-specific therapies due to its precapillary component.

Conclusions:

• PH-LHD is a complex condition with distinct pathophysiological stages.
• Current treatments for PH-LHD have not yielded significant benefits.
• Targeting the precapillary component in CpcPH with PAH-specific drugs warrants further investigation.