Pulmonary hypertension in left heart disease

Abstract

Pulmonary hypertension in left heart disease (PH-LHD) is the most prevalent form of PH. It is classified as group 2 PH as per WHO classification. As the prevalence of left heart disease such as congestive heart failure is increasing, the number of patients with associated PH is rising, coupled with high morbidity and mortality. Pulmonary hypertension is initially passive or isolated post-capillary (Ipc-PH) due to increased left sided filling pressures. In long standing cases pre-capillary component is added due to development of pulmonary vascular disease, termed combined post- and pre-capillary PH (Cpc-PH) or reactive PH. We describe the hemodynamics, pathophysiology, role of echocardiography and right heart catheterization in PH-LHD. We discuss the significance of PH associated with congestive heart failure as well as valvular heart disease. Although there is no treatment for PH-LHD, we discuss and critically analyze various studies investigating the role of pulmonary vasodilators in this condition. As PH-LHD is an under studied disease, we highlight the areas where further research is required.

Keywords

• pulmonary hypertension
• left heart disease
• congestive heart failure
• pre-capillary
• post-capillary
• pulmonary artery pressure