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Semin Respir Crit Care Med 2017; 38(05): 662-676
DOI: 10.1055/s-0037-1606576
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Hypertension Due to Left Heart Disease

Mario Gerges
1   Division of Cardiology, Department of Internal Medicine II, General Hospital Vienna (AKH-Wien), Medical University of Vienna, Vienna, Austria
,
Christian Gerges
1   Division of Cardiology, Department of Internal Medicine II, General Hospital Vienna (AKH-Wien), Medical University of Vienna, Vienna, Austria
,
Robert Naeije
2   Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium
,
Irene M. Lang
1   Division of Cardiology, Department of Internal Medicine II, General Hospital Vienna (AKH-Wien), Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
15 October 2017 (online)

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Abstract

Pulmonary hypertension (PH) due to left heart disease (PH-LHD) is a significant predictor of outcome for patients with any type of heart failure (HF), and represents a subset of PH affecting a large number of patients. Because the condition is no standalone inherent pulmonary vascular disorder but the consequence of heart disease, its understanding is dependent on a thorough insight in current HF epidemiology, pathophysiology, diagnosis, and treatments. Although the age-specific incidence of HF is decreasing, this trend is less dramatic for HF with preserved ejection fraction than for HF with reduced ejection fraction. Both the current 2015 ESC/ERS guidelines for the diagnosis and treatment of PH, and the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic HF have adopted new insights in the current understanding of PH-LHD (PH group 2), but no consensus has been reached. Due to multimorbidity, advanced age, referral biases, and a large proportion of noncardiovascular deaths in this population, proper hemodynamic and clinical characterization of patients with and without significant pulmonary vascular disease is important. Definitions largely depend on fluid status which should be assessed prior to any hemodynamic assessment. Benefit from pulmonary arterial hypertension–targeted treatments appears unlikely from today's perspective, but there is an immense unmet need for any treatments of this condition, and proper trials still have to be done.

Keywords

heart failure - hemodynamics - left heart disease - pulmonary hypertension

Authors' Contributions

Drafting of the manuscript: M.G., C.G., R.N., I.M.L.


Critical revision of the manuscript and final approval of the version to be published: M.G., C.G., R.N., I.M.L.


All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


The corresponding author, Irene M. Lang, has had full access to all data and assumes final responsibility for the decision to submit for publication.


Sources of Funding

The group of I.M.L. is supported by FWF F54, KLI209, and W1205.


 

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