Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA.
Division of Cardiology, University of California Davis, Sacramento, California, USA.
JACC Heart Fail. 2024 Aug;12(8):1328-1342. doi: 10.1016/j.jchf.2024.04.031. Epub 2024 Jul 3.
Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies-pharmacologic, device-based, and surgical therapies used for managing PH-LHD-are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.
与左心疾病相关的肺动脉高压（PH-LHD）仍然是全球最常见的肺动脉高压病因。病因包括射血分数降低和保留的心力衰竭以及左侧瓣膜性心脏病。尽管 PH-LHD 的患病率不断增加，但临床医生对其血流动力学定义、诊断、治疗方式和预后仍然知之甚少。此外，临床试验对肺动脉高压扩张剂治疗 PH-LHD 的有效性产生了混合结果。在这篇专家综述中，我们概述了对诊断不确定病例进行仔细血流动力学评估和激发试验的关键作用。还概述了用于治疗 PH-LHD 的治疗策略——药物、器械和手术治疗。还简要探讨了晚期心力衰竭中的 PH-LHD 以及机械循环支持在 PH-LHD 中的作用。所有临床医生都需要深入了解 PH-LHD，以提高对 PH-LHD 患者的认识和改善其预后。
