Left ventricular heart failure and pulmonary hypertension

Abstract

In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context.

Pulmonary hypertension associated with antiphospholipid antibody: Call for a screening tool?

“…This endocarditis is present in about 20% to 30% of patients with SLE and about a third of patients with primary APS (31)(32)(33). These lead to a significant amount of valvular regurgitation and can lead to left heart failure and associated pulmonary venous hypertension (PVH) (34). The risk of valvular heart disease is highest for patients with lupus anticoagulant and anti-cardiolipin antibodies (IgG) (35).…”

Pathophysiology in Heart Failure

“…Therefore, LHF is the most common (65-80%) reason for PAH (group 2 PAH) [17]. Sudden elevation of the left heart and consequently pulmonary circulatory pressure increases endothelial permeability causing fluid infiltration into alveolar and interstitial spaces.…”

Nadciśnienie płucne w przebiegu chorób lewego serca — aktualne leczenie i kierunki rozwoju terapii

“…Obie składowe -aktywny wzrost napięcia błony mięśniowej i przebudowa ściany -prowadzą do wzrostu PVR. Rozwija się złożone pre-i postkapilarne PH [14].…”