scholarly journals Pulmonary hypertension due to left heart disease

2019 ◽  
Vol 53 (1) ◽  
pp. 1801897 ◽  
Author(s):  
Jean-Luc Vachiéry ◽  
Ryan J. Tedford ◽  
Stephan Rosenkranz ◽  
Massimiliano Palazzini ◽  
Irene Lang ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Left Heart ◽  
Complex Situation ◽  
Non Invasive ◽  
The Past ◽  
Left Heart Disease ◽  
Pulmonary Arterial ◽  
Wedge Pressure ◽  
Group 1

Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over the past 5 years since the 5th World Symposium on Pulmonary Hypertension in 2013, leading to a better understanding of PH-LHD, challenges and gaps in evidence. PH in heart failure with preserved ejection fraction represents the most complex situation, as it may be misdiagnosed with group 1 PH. Based on the latest evidence, we propose a new haemodynamic definition for PH due to LHD and a three-step pragmatic approach to differential diagnosis. This includes the identification of a specific “left heart” phenotype and a non-invasive probability of PH-LHD. Invasive confirmation of PH-LHD is based on the accurate measurement of pulmonary arterial wedge pressure and, in patients with high probability, provocative testing to clarify the diagnosis. Finally, recent clinical trials did not demonstrate a benefit in treating PH due to LHD with pulmonary arterial hypertension-approved therapies.

Pulmonary hypertension due to left heart disease with pulmonary arterial wedge pressure ≤15 mm Hg

Herz ◽  
2020 ◽  
Author(s):  
Dongxu Xu ◽  
Hao Zhang ◽  
Huiling Cheng ◽  
Tianbao Xu ◽  
Wei Sun ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Left Heart ◽  
Left Heart Disease ◽  
Pulmonary Arterial ◽  
Wedge Pressure

Pulmonary arterial wedge pressure =21 mmHg during exercise unmasks occult left heart disease in exercise pulmonary hypertension

2019 ◽  
Author(s):  
Simon Dominik Herkenrath ◽  
Marcel Treml ◽  
Ilona Kietzmann ◽  
Norbert Anduleit ◽  
Georgios Sofianos ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Left Heart ◽  
Left Heart Disease ◽  
Pulmonary Arterial ◽  
Wedge Pressure

scholarly journals Under pressure: pulmonary hypertension associated with left heart disease

2015 ◽  
Vol 24 (138) ◽  
pp. 665-673 ◽  
Author(s):  
Harrison W. Farber ◽  
Simon Gibbs
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Survival Rates ◽  
Left Ventricular ◽  
Left Heart ◽  
Mean Pulmonary Arterial Pressure ◽  
Left Heart Disease ◽  
Right Heart Catheterisation ◽  
Pulmonary Capillary ◽  
Pulmonary Arterial

Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common type of PH, but its natural history is not well understood. PH-LHD is diagnosed by right heart catheterisation with a mean pulmonary arterial pressure ≥25 mmHg and a pulmonary capillary wedge pressure >15 mmHg. The primary causes of PH-LHD are left ventricular dysfunction of systolic and diastolic origin, and valvular disease. Prognosis is poor and survival rates are low. Limited progress has been made towards specific therapies for PH-LHD, and management focuses on addressing the underlying cause of the disease with supportive therapies, surgery and pharmacological treatments. Clinical trials of therapies for pulmonary arterial hypertension in patients with PH-LHD have thus far been limited and have provided disappointing or conflicting results. Robust, long-term clinical studies in appropriate target populations have the potential to improve the outlook for patients with PH-LHD. Herein, we discuss the knowledge gaps in our understanding of PH-LHD, and describe the current unmet needs and challenges that are faced by clinicians when identifying and managing patients with this disease.

scholarly journals The pathophysiology of pulmonary hypertension in left heart disease

2015 ◽  
Vol 309 (9) ◽  
pp. L924-L941 ◽  
Author(s):  
Siegfried Breitling ◽  
Krishnan Ravindran ◽  
Neil M. Goldenberg ◽  
Wolfgang M. Kuebler
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Fluid Transport ◽  
Poor Response ◽  
Left Heart ◽  
Left Heart Disease ◽  
Wide Range ◽  
Pulmonary Arterial ◽  
Preclinical Animal Models

Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure leading to right-sided heart failure and can arise from a wide range of etiologies. The most common cause of PH, termed Group 2 PH, is left-sided heart failure and is commonly known as pulmonary hypertension with left heart disease (PH-LHD). Importantly, while sharing many clinical features with pulmonary arterial hypertension (PAH), PH-LHD differs significantly at the cellular and physiological levels. These fundamental pathophysiological differences largely account for the poor response to PAH therapies experienced by PH-LHD patients. The relatively high prevalence of this disease, coupled with its unique features compared with PAH, signal the importance of an in-depth understanding of the mechanistic details of PH-LHD. The present review will focus on the current state of knowledge regarding the pathomechanisms of PH-LHD, highlighting work carried out both in human trials and in preclinical animal models. Adaptive processes at the alveolocapillary barrier and in the pulmonary circulation, including alterations in alveolar fluid transport, endothelial junctional integrity, and vasoactive mediator secretion will be discussed in detail, highlighting the aspects that impact the response to, and development of, novel therapeutics.

Modeling survival using decision tree analysis in pulmonary hypertension due to left heart disease. the prognostic significance of PVR <3WU when TAPSE <16mm

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Raitiere ◽  
E Berthelot ◽  
C Fauvel ◽  
P Guignant ◽  
N Si-Belkacem ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Decision Tree ◽  
Pressure Gradient ◽  
Right Ventricular ◽  
Decision Tree Analysis ◽  
Left Heart ◽  
Tree Analysis ◽  
Left Heart Disease ◽  
Wedge Pressure

Abstract Aims In 2019, PVR&lt;3 WU was adopted to stratify patients at low risk of pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether the supervised machine learning with Decision Tree analysis that provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification. Methods 202 consecutive patients (mean age: 69±11 y, females 42%) with mean pulmonary artery pressure (mPAP)≥20mmHg and wedge pressure&gt;15mmHg were recruited. Transpulmonary pressure gradient ≥12mmHg, pulmonary vascular resistance (PVR) ≥3WU, diastolic pressure gradient ≥7mmHg, pulmonary arterial capacitance&lt;1.1 ml/mmHg, TAPSE&lt;16 mm, peak systolic tissue Doppler velocity&lt;10cm/s and right ventricular end-diastolic area ≥25 cm2 were the seven categorical values to enter the model. To predict the mortality from the Decision Tree, we used the CHAID method. Each node and branch were compared using survival analysis at 6-year follow-up. Results Mean PAP, wedge pressure, cardiac index, and PVR were 40.3±10.0mmHg, 22.3±7.1mm Hg, 2.9±0.8L/min/m2, and 3.6±2.1WU, respectively. Among the seven dichotomous values linked to the prognosis in PH-LHD, only 2 variables entered the model. To predict the mortality, TAPSE was first selected following by PVR. Compared to patients with PVR&lt;3WU and TAPSE ≥16mm, patients with PVR ≥3WU and TAPSE ≥16mm or patients with PVR ≥3WU and TAPSE &lt;16 mm has significant increased mortality (HR=3,0, 95% CI: [1,4–6,4], p=0.006 and HR=3,3, 95% CI: [1,6–6,9], p=0.002, respectively), while patients with PVR &lt;3WU and TAPSE &lt;16 mm exhibiting the worst prognosis (HR=7,2, 95% CI: [3,3–15,9], p=0.0001). Conclusion Used for solving regression and classification problems, decision tree analysis indicates that among 7 prognostic factors, TAPSE and PVR have to be interpreted altogether and simultaneously in PH-LHD for mortality assessment. Therefore, in future research, PVR &lt;3 WU should be understood primarily based on right ventricular systolic function assessed by echocardiography whether TAPSE is or not ≥16 mm. Funding Acknowledgement Type of funding source: None

scholarly journals Overview of WHO Group 2 Pulmonary Hypertension Due to Left Heart Disease

2015 ◽  
Vol 14 (2) ◽  
pp. 70-78 ◽  
Author(s):  
Christopher F. Barnett ◽  
Van N. Selby
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Patient Outcomes ◽  
Left Heart ◽  
Pulmonary Vasodilators ◽  
Poor Patient ◽  
Left Heart Disease ◽  
Pulmonary Arterial ◽  
Transplant Evaluation ◽  
Group 2

Background: Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH) and is associated with poor patient outcomes, especially among patients undergoing heart transplant evaluation. Implications for clinicians: Left heart disease should be considered in all patients undergoing an evaluation for PH. Correct management of PH from LHD is to optimize treatment of LHD. Pulmonary vasodilators used to treat pulmonary arterial hypertension should not be used in patients with PH from LHD. Conclusions: Additional research is needed to better understand how PH develops in patients with LHD and to investigate the role for treatment targeting PH in these patients.

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