What is it about?
This article summarizes the current knowledge on pulmonary hypertension in heart failure. It describes the epidemiology of PH in HFpEF and HFrEF and its prognostic relevance, the pathophysiology and hemodynamic interplay between left heart, pulmonary circulation and right heart, current definitions of pre- and post-capillary PH, and subclassification (IpcPH, CpcPH) of the latter. Furthermore, a diagnostic algorithm is provided for the distinction of PAH from PH associated with heart failure, and recommendations for treatment decisions in specific situations and for further research in this field are given.
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Why is it important?
While PH in heart failure is an important contributor to poor survival, there is currently no specific treatment, and there are many inconsistencies and lack of standardization in diagnostic work-up. Moreover, the pathophysiology is complex, but a number of recent publications has helped to increase our understanding of altered pulmonary hemodynamics in heart failure. This article provides the state-of-the-art knowledge from a clinical perspective, and provides detailled recommendations for diagnostic work-up, interpretation of test results, treatment decisions, and further research in this field.
Perspectives
Patients with heart failure and pulmonary hypertension display high morbidity and mortality, but diagnostic work-up is often poor, and no targeted treatments have been established, thus representing an important medical need. It is of key importance to increase our knowledge about the pathophysiology of PH in HF, to precisely understand the importance of single hemodynamic parameters for the distinctions between pulmonary congestion versus pulmonary vasculopathy in HF (IpcPH vs. CpcPH), and to use this information to (i) make clinical decisions in routine care, and (ii) designs future trials accordingly. Here, we provide a broad overview on the epidemiology and clinical relevance of PH in HF, describe the current knowledge about the pathophysiology in detail, and aim to help standardize diagnostic tests and the classification of PH. Our clinical goal must be to avoid unnecessary and potentially harmful PH therapies where they are not indicated, but establish evidence-based treatment recommendations in patients who have a therapeutic target in the pulmonary circulation.
Stephan Rosenkranz
Read the Original
This page is a summary of: Left ventricular heart failure and pulmonary hypertension, European Heart Journal, October 2015, European Society of Cardiology,
DOI: 10.1093/eurheartj/ehv512.
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