Pulmonary Hypertension in Left Ventricular Valvular Diseases: A Comprehensive Review on Pathophysiology and Prognostic Value

Abstract

Left ventricular (LV) valvular diseases, make up one of the most common etiologies for pulmonary hypertension (PH), and it is not well understood how and at which degree it affects prognosis. The aim of the present study was a comprehensive review of the pathophysiologic mechanism of PH in patients with LV valvular diseases and the prognostic value of baseline and post-intervention PH in patients undergoing interventional treatment. The pathophysiology of PH in patients with LV valvular diseases involves gradual elevation of left ventricular filling pressure and left atrial pressure, which are passively transmitted to the pulmonary circulation and raise pulmonary artery systolic pressure (PASP). A long-lasting exposure to elevated PASP progressively leads to initially functional and thereafter irreversible structural changes in the pulmonary vasculature, leading up to high pulmonary vascular resistance. Surgical treatment of severe LV valvular diseases is highly effective in patients without resting PH or those with exercise-induced PH (EIPH) before intervention. In the case of pre-operative PH, successful interventional therapy decreases PASP, but the post-operative cardiac and all-cause mortality remain higher compared to patients without pre-operative PH. Hence, it is of paramount importance to detect patients with severe LV valvulopathies before the development of PH, since they will get greater benefits from early intervention.

The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension

“…Alternatively, rest echocardiography is widely used for initial screening for PH, because it is an easy, repeatable, inexpensive technique and its measurements show high correlation with RHC and unravel progressive right ventricular (RV) dysfunction. Echocardiography mainly calculates pulmonary arterial systolic pressure (PASP) and draws the probability of PH presence [4]. However, its diagnostic and prognostic role remains challenging due to a major limitation: its measurements rely on assumptions while altered hemodynamic conditions (such as severe tricuspid regurgitation; TR) may compromise the accuracy of echocardiographic parameters.…”