Management of Pulmonary Hypertension in Left Heart Disease

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.

Association between echocardiographic markers of pulmonary hypertension and short-term prognoses in patients with acute heart failure

“…Multivariate analysis showed that the risk ratio for mortality from any cause or rehospitalization and cardiovascular mortality for patients with a high probability of pulmonary hypertension was 1.67 and 2.7 times higher, respectively, than for patients with a low or moderate probability of PH, but decreased ejection fraction. Left ventricular fraction (LVEF<40) and proper ventricular function (reduced RVF) were not related to the primary outcome of the patient (9). These results are in line with the present study's findings.…”

“…In other studies, it has been reported that the predictive value of LVEF is not linear and is influenced by various intervening factors (25). Patients without RV dysfunction without PH were not at increased risk of mortality during one year of follow-up (9). These results show that the presence of PH with RV dysfunction provides important prognostic information for ADHF patients, which can help manage and evaluate ADHF patients.The results of a retrospective study by Dziewięcka et al on 502 patients with dilated cardiomyopathy (DCM) also showed that patients with a high and moderate probability of pulmonary hypertension (TRV > 3.4 m/s and TRV 2.9-3.4 m/s) on echocardiography were at increased risk.…”

“…Acute decompensated heart failure is one of the leading causes of hospitalization and mortality in patients over 65 years of age (8). Pulmonary hypertension (PH) is one of the complications of chronic heart failure (9). Pulmonary hypertension in heart failure patients is associated with a high risk of mortality and morbidity.…”

“…Still, diagnostic techniques are rarely available in the context of the standard management of ADHF patients (12). Also, the correct ventricular function is sensitive to afterload, and its diagnostic value may be closely related to PAP and PH (9). The probability of PH can be calculated based on the echocardiographic assessment of tricuspid valve peak systolic regurgitation velocity (TRV) and other signs of pulmonary hypertension, including evaluation of pulmonary artery indices and IVC and proper atrial indices (1).…”

Group 2 pulmonary hypertension: from diagnosis to treatment

“…Pulmonary hypertension frequently accompanies left heart disease (PHLHD) and is associated with worse prognosis than left heart disease without pulmonary hypertension [1][2][3]. Because of its frequency, prognostic implications, diagnostic challenges, and evolving treatment strategies, PHLHD is a frequent subject of publications [4 && , [5][6][7][8][9][10][11][12][13][14]. Diagnosis of PHLHD (group 2) requires recognition of patient characteristics that pose risk for having left heart disease.…”