Considerations in the Diagnosis and Management of Pulmonary Hypertension Associated With Left Heart Disease

Onyedika J. Ilonze*, Imo A. Ebong, Maya Guglin, Ajith Nair, Jonathan Rich, Vallerie McLaughlin, Ryan J. Tedford, Sula Mazimba

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1328-1342
Number of pages15
JournalJACC: Heart Failure
Volume12
Issue number8
DOIs
StatePublished - Aug 2024

Keywords

  • aortic regurgitation
  • aortic stenosis
  • heart failure with preserved ejection fraction
  • heart failure with reduced ejection fraction
  • left heart disease
  • mitral regurgitation
  • mitral stenosis
  • pulmonary hypertension
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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