Pulmonary hypertension due to left heart diseases

Abstract

Pulmonary hypertension is a common complication of left heart diseases. Although it may be encountered in all disorders, pulmonary hypertension in left heart disease is most common in heart failure with preserved or reduced ejection fraction. When present, pulmonary hypertension in left heart disease has been associated with more symptoms, exercise intolerance, and a negative impact on outcome.

Hemodynamic assessment and acute pulmonary vasoreactivity testing in the evaluation of children with pulmonary vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

“…In patients with PH due to LHD (PH-LHD) (defined as mPAP ≥25 mm Hg and PAWP ≥15 mm Hg), the DPD (DPD=dTPG=dPAP—PAWP) should be considered to rule out any additional precapillary PAH-component,18 26 27 instead of the mean TPG (mTPG=mPAP—PAWP). The mTPG is influenced by all determinants of mPAP, including flow, resistance and left heart-filling pressure.…”

“…The mTPG is influenced by all determinants of mPAP, including flow, resistance and left heart-filling pressure. In contrast, diastolic PAP, when compared with systolic and mean PAPs, is less influenced by cardiac output, which might be explained by a lower sensitivity to vessel distensibility 18 27. Therefore, dTPG (DPD) seems to provide the most reliable characteristics to determine pulmonary vascular disease and PVR.…”

“…A dTPG (DPD) of ≥7 mm Hg has been identified to predict worse outcome in adult patients with PH due to LHD,26 however in a very recent study this association could not be confirmed 28. At the fifth World Symposium on PH in Nice 2013, the expert panel released a definition on postcapillary PH with additional precapillary PAH (formerly known as ‘out- of-proportion’ PH) as a TPG ≥15mmHg and a DPD ≥7 mm Hg 27. Whether these normal values are also appropriate for the paediatric population cannot reliably be stated as at this date, since corresponding specific paediatric data are needed.…”

Right ventricular exercise contractile reserve and outcomes after early surgery for primary mitral regurgitation

“…The progressive LV remodelling results in a rise in LV end-diastolic pressure that can be transmitted backwards, which causes left atrial dilatation and increased pulmonary postcapillary pressure. In the final stage, RV dysfunction develops as a direct consequence of the increased sPAP 24. Despite this, several studies conducted on patients with left-sided heart valve disease have been published which show that sPAP is not the main correlate of RV function 7 25 26.…”

Update in Pulmonary Vascular Disease 2015

“…A diastolic pressure gradient (DPG) equal to or exceeding 7 mm Hg was reported to discriminate pulmonary vascular disease in the setting of left heart dysfunction, also referred to as combined postcapillary PH and precapillary PH (28)(29)(30)(31)(32). DPG is the difference between pulmonary artery diastolic pressure and left ventricular (LV) end-diastolic pressure (i.e., pulmonary artery wedge pressure).…”