Left Ventricular Dysfunction With Pulmonary Hypertension

Georgiopoulou, Vasiliki V.; Καλογερόπουλος, Ανδρέας; Borlaug, Barry A.; Gheorghiade, Mihai; Butler, Javed

doi:10.1161/circheartfailure.112.000095

Cited by 47 publications

(28 citation statements)

References 114 publications

(160 reference statements)

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“…The diagnosis and management of PH from left heart disease‐group 2 PH has been extensively reviewed 152, 153, 154, 155, 156. Venous (postcapillary) PH, resulting from enduring elevation in left atrial (LA) pressure, is the most common cause of PH 157, 158.…”

Section: Ph Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

107

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Section: Ph Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

107

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“…4 Pulmonary arterial hypertension can be idiopathic or occur secondary to conditions such as left heart failure, lung disease, hypoxia, or thromboembolism and is associated with a poor clinical outcome. 5 Regardless of the initiating cardiac abnormality, the syndrome of heart failure represents a complex clinical picture, including abnormal myocardial contractility, altered hemodynamics, ventricular remodeling, and neurohumoral activation. 6 Currently β-blockers, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), nitrites, digoxin, aldosterone antagonists, implantable cardioverter-defibrillators, cardiac resynchronization therapy, left ventricular assist devices, and heart transplantation are available approaches to treat and manage heart failure.…”

mentioning

confidence: 99%

“…10 Although current treatment strategies delay or lessen the worsening of heart failure, the prognosis of patients with heart failure remains poor. 5,[11][12][13] The 1-year and 5-year mortalities are 20% and 50% respectively. 14 The cost of managing patients with heart failure in the United States is approximately $39 billion.…”

mentioning

confidence: 99%

Cardiac Energy Metabolic Alterations in Pressure Overload–Induced Left and Right Heart Failure (2013 Grover Conference Series)

Sankaralingam

Lopaschuk

2015

Pulm. circ.

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Pressure overload of the heart, such as seen with pulmonary hypertension and/or systemic hypertension, can result in cardiac hypertrophy and the eventual development of heart failure. The development of hypertrophy and heart failure is accompanied by numerous molecular changes in the heart, including alterations in cardiac energy metabolism. Under normal conditions, the high energy (adenosine triphosphate [ATP]) demands of the heart are primarily provided by the mitochondrial oxidation of fatty acids, carbohydrates (glucose and lactate), and ketones. In contrast, the hypertrophied failing heart is energy deficient because of its inability to produce adequate amounts of ATP. This can be attributed to a reduction in mitochondrial oxidative metabolism, with the heart becoming more reliant on glycolysis as a source of ATP production. If glycolysis is uncoupled from glucose oxidation, a decrease in cardiac efficiency can occur, which can contribute to the severity of heart failure due to pressure-overload hypertrophy. These metabolic changes are accompanied by alterations in the enzymes that are involved in the regulation of fatty acid and carbohydrate metabolism. It is now becoming clear that optimizing both energy production and the source of energy production are potential targets for pharmacological intervention aimed at improving cardiac function in the hypertrophied failing heart. In this review, we will focus on what alterations in energy metabolism occur in pressure overload induced left and right heart failure. We will also discuss potential targets and pharmacological approaches that can be used to treat heart failure occurring secondary to pulmonary hypertension and/or systemic hypertension.

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“…The conventional cardiovascular risk factors are not likely the explanation for the added risk, as their prevalence was comparable among the subgroups. However, pulmonary hypertension is possibly an important comorbidity, which can result from LVSD32, 33, 34 or IPF 35, 36. Whether due to LVSD37, 38 or IPF,39, 40, 41 pulmonary hypertension is associated with significantly increased morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

Waheed

Chaves

Gardin

et al. 2015

JAHA

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BackgroundImpaired pulmonary function (IPF) and left ventricular systolic dysfunction (LVSD) are prevalent in the elderly and are associated with significant morbidity and mortality. The main objectives of this study were to examine the relative impact and joint association of IPF and LVSD with heart failure, cardiovascular mortality and all‐cause mortality, and their impact on risk classification using a continuous net reclassification index.Methods and ResultsWe followed 2342 adults without prevalent cardiovascular disease (mean age, 76 years) from the Cardiovascular Health Study for a median of 12.6 years. LVSD was defined as LV ejection fraction <55%. IPF was defined as: forced expiratory volume in 1 second:forced vital capacity <70%, and predicted forced expiratory volume in 1 second <80%. Outcomes included heart failure hospitalization, cardiovascular mortality, all‐cause mortality, and composite outcome. LVSD was detected in 128 subjects (6%), IPF in 441 (19%) and both in 38 (2%). Compared to those without LVSD or IPF, there was a significantly increased cardiovascular risk for groups of LVSD only, IPF only, and LVSD plus IPF, adjusted hazard ratio (95% CI) 2.1 (1.5–3.0), 1.7 (1.4–2.1), and 3.2 (2.0–5.1) for HF; 1.8 (1.2–2.6), 1.4 (1.1–1.8), and 2.8 (1.7–4.7) for cardiovascular mortality; 1.3 (1.0–1.8), 1.7 (1.4–1.9), and 2.1 (1.5–3.0) for all‐cause mortality, and 1.6 (1.3–2.1), 1.7 (1.5–1.9), and 2.4 (1.7–3.3) for composite outcome, respectively. Risk classification improved significantly for all outcomes when IPF was added to the adjusted model with LVSD or LVSD to IPF.ConclusionsWhile risk of cardiovascular outcomes was the highest among elderly with both LVSD and IPF, risk was comparable between subjects with IPF alone and those with LVSD alone. This observation, combined with improved risk classification by adding IPF to LVSD or LVSD to IPF, underscore the importance of comprehensive heart and lung evaluation in cardiovascular outcome assessment.

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Left Ventricular Dysfunction With Pulmonary Hypertension

Abstract: Group 2 PH, Part 1 345vasodilators. Passive PH would generally not be considered a plausible target for therapy with a pulmonary arterial selective agent.

Cited by 47 publications

References 114 publications

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Cardiac Energy Metabolic Alterations in Pressure Overload–Induced Left and Right Heart Failure (2013 Grover Conference Series)

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

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