Pulmonary Hypertension Related to Left Heart Disease (PH-LHD)

Abstract

Abstract: Pulmonary Hypertension secondary to left heart disease (PH-LHD) is the most common form of pulmonary hypertension (PH) and is a frequent complication of heart failure. It is associated with increased morbidity and mortality. The definitions of both PH and PH-LHD have changed over time and now generally follow those established by the 6th World Symposium on Pulmonary Hypertension (WSPH) in 2018 and the most recent European Society of Cardiology (ESC) guidelines in 2022. A systematic approach including clinical history and noninvasive testing is required to properly diagnose PH-LHD, and accurate hemodynamics by right heart catheterization, sometimes involving provocative testing, are often needed to diagnose PH-LHD but are essential to further subclassify PH-LHD into either isolated post-capillary pulmonary hypertension (Ipc-PH) versus combined pre and post-capillary pulmonary hypertension (Cpc-PH). This distinction is important as it guides therapeutic decisions and carries prognostic implications. Cpc-PH, in particular, shares some histo-pathologically and hemodynamically characteristics with pulmonary arterial hypertension (PAH) and, hence, the rationale for the potential use of pulmonary vasodilator therapy. To date, however, there is no strong evidence to support PAH-specific medications for Cpc-PH, and the mainstay of treatment for PH-LHD remains to treat the underlying cause of LHD. Further research is warranted to refine therapeutic approaches, improve long-term outcomes, and explore novel treatment modalities to alleviate the burden of PH in this patient population.