Management of Pulmonary Hypertension due to Heart Failure with Preserved Ejection Fraction

Kanwar, Manreet; Tedford, Ryan J.; Agarwal, Richa; Clarke, Megan M.; Walter, Claire; Sokos, George; Murali, Srinivas; Benza, Raymond L.

doi:10.1007/s11906-014-0501-5

Cited by 5 publications

(4 citation statements)

References 62 publications

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“…In contrast, a single‐center, placebo‐controlled, randomized trial reported significant improvements in PA pressure, RV function, and LV relaxation with sildenafil in patients with HFpEF and PH . In the absence of evidence‐based data, PDE5‐I cannot be recommended for the treatment of PH in HFpEF . Riociguat, a soluble guanylate cyclase stimulator that sensitizes guanylate cyclase through nitric oxide–dependent and –independent pathways, has been evaluated for the treatment of PH in HFpEF .…”

Section: Ph Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

110

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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

110

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“…In PAH, the mean PAWP is ≤15mmHg, whereas in PH-LHD, the mPAWP is >15 mmHg [9]. This hemodynamic difference ensues from the chronic elevation in LV end-diastolic and left atrial pressure (LAP), which are triggers for the development of PH in HFpEF and HFrEF [36]. The elevation of pulmonary artery pressure (PAP) in the initial phase of the development of PH-HFpEF is, therefore, considered a passive reflection of LAP in the pulmonary circulation [37].…”

Section: Hemodynamic and Pathobiological Alterations In Ph-hfpefmentioning

confidence: 99%

“…HFpEF and HFrEF [36]. The elevation of pulmonary artery pressure (PAP) in the initial phase of the development of PH-HFpEF is, therefore, considered a passive reflection of LAP in the pulmonary circulation [37].…”

Section: Hemodynamic and Pathobiological Alterations In Ph-hfpefmentioning

confidence: 99%

Structural and Hemodynamic Changes of the Right Ventricle in PH-HFpEF

Barilli

Tavera

Valente

et al. 2022

IJMS

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One of the most important diagnostic challenges in clinical practice is the distinction between pulmonary hypertension (PH) due to primitive pulmonary arterial hypertension (PAH) and PH due to left heart diseases. Both conditions share some common characteristics and pathophysiological pathways, making the two processes similar in several aspects. Their diagnostic differentiation is based on hemodynamic data on right heart catheterization, cardiac structural modifications, and therapeutic response. More specifically, PH secondary to heart failure with preserved ejection fraction (HFpEF) shares features with type 1 PH (PAH), especially when the combined pre- and post-capillary form (CpcPH) takes place in advanced stages of the disease. Right ventricular (RV) dysfunction is a common consequence related to worse prognosis and lower survival. This condition has recently been identified with a new classification based on clinical signs and progression markers. The role and prevalence of PH and RV dysfunction in HFpEF remain poorly identified, with wide variability in the literature reported from the largest clinical trials. Different parenchymal and vascular alterations affect the two diseases. Capillaries and arteriole vasoconstriction, vascular obliteration, and pulmonary blood fluid redistribution from the basal to the apical district are typical manifestations of type 1 PH. Conversely, PH related to HFpEF is primarily due to an increase of venules/capillaries parietal fibrosis, extracellular matrix deposition, and myocyte hypertrophy with a secondary “arteriolarization” of the vessels. Since the development of structural changes and the therapeutic target substantially differ, a better understanding of pathobiological processes underneath PH-HFpEF, and the identification of potential maladaptive RV mechanisms with an appropriate diagnostic tool, become mandatory in order to distinguish and manage these two similar forms of pulmonary hypertension.

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“…Indeed, a substantial component of RV contractility is due to LV, through shared short axis fibers and trans-septal contribution. In HFpEF patients, despite normal ejection fraction (EF), LV evidences some degrees of impaired contractility (due to reduced longitudinal systolic function or diastolic dysfunction) and consequently impaired RV/ LV interactions (29). In this setting RV loses its ability to compensate the pressure overload, causing a ventricularvascular uncoupling.…”

Section: Rh Characteristicsmentioning

confidence: 99%

Pulmonary arterial hypertension and heart failure with preserved ejection fraction: are they so discordant?

Ruocco

Gavazzi

Gonnelli

et al. 2020

Cardiovasc Diagn Ther

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Heart failure with preserved ejection fraction (HFpEF) and pulmonary arterial hypertension (PAH) are two emerging diseases focusing the attention of numerous researchers. In the last PAH guideline, there is a crossroad between the two diseases and pulmonary hypertension (PH) due to heart failure (HF) is categorized as subtype 2. In order to assess the correct diagnosis and management, it should be better understood the points of convergence and divergence of two diseases. Although, risk factors, demographic characteristics and haemodynamics are different, we report several similarities regarding vascular alterations, some aspects of cardiac remodelling, and clinical presentation. This model suggests HFpEF and PAH as two comparable conditions, with different cardiac adaptation and trajectories, linked to the intrinsic properties of either right and left ventricles. In both diseases the early pathophysiological mechanisms appear to begin from peripheral vasculature and to be backward transmitted to the larger arterial vascular district, and eventually to the myocardial structure. In this paper we would propose a simple approach to recognize the concordances and, all at once, distinguish the peculiarities of the two diseases.

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Management of Pulmonary Hypertension due to Heart Failure with Preserved Ejection Fraction

Cited by 5 publications

References 62 publications

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Structural and Hemodynamic Changes of the Right Ventricle in PH-HFpEF

Pulmonary arterial hypertension and heart failure with preserved ejection fraction: are they so discordant?

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