Left Ventricular Diastolic Heart Function and Pulmonary Hypertension

Abstract

Pulmonary venous hypertension is now one of the most common causes of pulmonary hypertension (PH) diagnosed by both pulmonologists and cardiologists. Patients with pulmonary venous hypertension will typically have elevated pulmonary venous pressure (as reflected in the pulmonary capillary wedge pressure), most frequently as a reflection of increased left ventricular end-diastolic pressure. Although mitral stenosis was the most common cause of this entity decades ago, left ventricular diastolic dysfunction is the most common cause of pulmonary venous hypertension seen in the Western world today. The mechanisms for the hypertension in mitral stenosis and in left ventricular diastolic abnormalities are thought to be similar. A chronic elevation in the diastolic filling pressure of the left side of the heart causes a backward transmission of the pressure to the pulmonary venous system which appears to trigger vasoconstriction in the pulmonary arterial bed. The current accepted designation is PH secondary to heart failure with a preserved ejection fraction.