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. 2021 Jul 1;17(2):115-123.
doi: 10.14797/RKQN5397. eCollection 2021.

Management of Pulmonary Hypertension in Left Heart Disease

Francesca Macera  1   2 , Jean-Luc Vachiéry  1
Affiliations

Management of Pulmonary Hypertension in Left Heart Disease

Francesca Macera et al. Methodist Debakey Cardiovasc J. .

Abstract

Pulmonary hypertension due to left heart diseases (PH-LHD) is the most prevalent form of pulmonary hypertension. It frequently complicates heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) and negatively impacts prognosis, particularly when a precapillary component is present. PH-LHD is distinctive from pulmonary arterial hypertension (PAH) even though both conditions may share some common characteristics. In addition, the mechanisms involved in the development of a precapillary component are yet to be fully clarified, in particular in PH due to HFpEF. Several studies have been exploring PAH pathways as potential therapies for PH-LHD, but no PAH-approved drug has demonstrated efficacy in PH-LHD. Rather, some classes of drugs, such as endothelin-receptor antagonists or prostacycline-analogues, have been found to be harmful in patients with HF. Therefore, at present, the only established treatments for PH-LHD are those that target the heart as recommended in the international guidelines for HF. Based on current knowledge, off-label prescription of PAH-approved drugs in PH-LHD patients must be strongly discouraged.

Keywords: heart failure; hemodynamics; left heart disease; pulmonary circulation; pulmonary hypertension.

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References

    1. Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009. March 31; 53(13): 1119–26. doi: 10.1016/j.jacc.2008.11.051. - DOI - PMC - PubMed
    1. Galié N, Humbert M, Vachiéry JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016. January 1; 37(1): 67–119. doi: 10.1093/eurheartj/ehv317. - DOI - PubMed
    1. Vachiéry JL, Tedford RJ, Rosenkranz S, et al. Pulmonary hypertension due to left heart disease. Eur Respir J. 2019. January 24; 53(1): 1801897. doi: 10.1183/13993003.01897-2018. - DOI - PMC - PubMed
    1. Rosenkranz S, Gibbs JSR, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiéry JL. Left ventricular heart failure and pulmonary hypertension. Eur Heart J. 2016. March 21; 37(12): 942–54. doi: 10.1093/eurheartj/ehv512. - DOI - PMC - PubMed
    1. Assad TR, Hemnes AR, Larkin EK, et al. Clinical and biological insights into combined post-capillary and pre-capillary pulmonary hypertension. 2016. December 13; 68(23): 2525–2536. doi: 10.1016/j.jacc.2016.09.942. - DOI - PMC - PubMed

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