TY - JOUR
T1 - Considerations in the Diagnosis and Management of Pulmonary Hypertension Associated With Left Heart Disease
AU - Ilonze, Onyedika J.
AU - Ebong, Imo A.
AU - Guglin, Maya
AU - Nair, Ajith
AU - Rich, Jonathan
AU - McLaughlin, Vallerie
AU - Tedford, Ryan J.
AU - Mazimba, Sula
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/8
Y1 - 2024/8
N2 - Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies—pharmacologic, device-based, and surgical therapies used for managing PH-LHD—are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.
AB - Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies—pharmacologic, device-based, and surgical therapies used for managing PH-LHD—are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.
KW - aortic regurgitation
KW - aortic stenosis
KW - heart failure with preserved ejection fraction
KW - heart failure with reduced ejection fraction
KW - left heart disease
KW - mitral regurgitation
KW - mitral stenosis
KW - pulmonary hypertension
KW - valvular heart disease
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U2 - 10.1016/j.jchf.2024.04.031
DO - 10.1016/j.jchf.2024.04.031
M3 - Review article
C2 - 38970588
AN - SCOPUS:85198554323
SN - 2213-1779
VL - 12
SP - 1328
EP - 1342
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 8
ER -