Pulmonary Hypertension (PH) related to Left Heart Disease (LHD) is the most common form
of PH, accounting for more than two third of all PH cases. The hemodynamic abnormalities seen in PHLHD
are complex, and there are currently minimal evidence-based recommendations for the management
of PH-LHD. While it is accepted that PH in the context of left heart disease is a marker of worse
prognosis, it remains unclear whether its primary treatment is beneficial or harmful. In this article, we
discuss the prevalence and significance of PH in patients with Heart Failure (HF) with Reduced Ejection
Fraction (HFrEF) as well as HF with Preserved Ejection Fraction (HFpEF), and those with valvular
heart disease and provide insights into the complex pathophysiology of cardiopulmonary interrelationship
in individuals with PH due to left heart disease. Furthermore, we provide a framework for diagnostic
testing and an approach to optimal management of these complex patients based on current European
Society of Cardiology (ESC) guidelines.
Keywords: Pulmonary hypertension, left heart disease, heart failure, pulmonary vascular resistance, pulmonary vasodilator,
valvular heart disease.
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