open access

Vol 12, No 3 (2017)
Cardiac Surgery
Published online: 2017-06-30
Get Citation

Pulmonary hypertension due to left heart disease — review of the treatment and directions of development

Danuta Karasek, Władysław Sinkiewicz
DOI: 10.5603/FC.2017.0061
·
Folia Cardiologica 2017;12(3):317-325.

open access

Vol 12, No 3 (2017)
Cardiac Surgery
Published online: 2017-06-30

Abstract

Chronic heart failure is a disease with growing importance in modern cardiology. In spite of a significant progress the
treatment results are still far from satisfactory. Pulmonary hypertension (PH) is a harbinger of poor prognosis in this
group of patients increasing the risk of hospitalisation and death. Pulmonary hypertension secondary to left heart
diseases is a result of diastolic and systolic dysfunction leading to increased left ventricular filling pressures. That, in
turn, is followed by further unfavourable pathophysiological and functional changes in pulmonary circulation ultimately
causing right ventricular failure. Diagnosis and treatment of pulmonary hypertension is not an easy task. Thankfully,
the development of diagnostic methods, uniformed terminology and a new classification of pulmonary hypertension
allow for faster and more precise diagnosis and qualification of patients to the appropriate clinical subgroup. Right heart
catheterization is crucial for the final diagnosis and classification of pulmonary hypertension. Proper methodology of
the examination and drawing appropriate conclusions from available haemodynamic and clinical data is essential for
further therapeutic management. Most of targeted therapies are addressed to patients with pulmonary arterial hypertension and the administration of these drugs in PH-LHD was either not sufficiently studied in randomized trials or was proved to cause the harm. There is a distinct need for further research on basic mechanisms of PH-LHD as well as on
novel therapeutic strategies that may stimulate the development of new guidelines on the treatment of this growing
population of PH patients.

Abstract

Chronic heart failure is a disease with growing importance in modern cardiology. In spite of a significant progress the
treatment results are still far from satisfactory. Pulmonary hypertension (PH) is a harbinger of poor prognosis in this
group of patients increasing the risk of hospitalisation and death. Pulmonary hypertension secondary to left heart
diseases is a result of diastolic and systolic dysfunction leading to increased left ventricular filling pressures. That, in
turn, is followed by further unfavourable pathophysiological and functional changes in pulmonary circulation ultimately
causing right ventricular failure. Diagnosis and treatment of pulmonary hypertension is not an easy task. Thankfully,
the development of diagnostic methods, uniformed terminology and a new classification of pulmonary hypertension
allow for faster and more precise diagnosis and qualification of patients to the appropriate clinical subgroup. Right heart
catheterization is crucial for the final diagnosis and classification of pulmonary hypertension. Proper methodology of
the examination and drawing appropriate conclusions from available haemodynamic and clinical data is essential for
further therapeutic management. Most of targeted therapies are addressed to patients with pulmonary arterial hypertension and the administration of these drugs in PH-LHD was either not sufficiently studied in randomized trials or was proved to cause the harm. There is a distinct need for further research on basic mechanisms of PH-LHD as well as on
novel therapeutic strategies that may stimulate the development of new guidelines on the treatment of this growing
population of PH patients.

Get Citation

Keywords

heart failure, pulmonary hypertension

About this article
Title

Pulmonary hypertension due to left heart disease — review of the treatment and directions of development

Journal

Folia Cardiologica

Issue

Vol 12, No 3 (2017)

Pages

317-325

Published online

2017-06-30

DOI

10.5603/FC.2017.0061

Bibliographic record

Folia Cardiologica 2017;12(3):317-325.

Keywords

heart failure
pulmonary hypertension

Authors

Danuta Karasek
Władysław Sinkiewicz

References (45)
  1. Georgiopoulou VV, Kalogeropoulos AP, Borlaug BA, et al. Left Ventricular Dysfunction With Pulmonary Hypertension: Part 1: Epidemiology, Pathophysiology, and Definitions. Circulation: Heart Failure. 2013; 6(2): 344–354.
  2. Schmeisser A, Schroetter H, Braun-Dulleaus RC. Management of pulmonary hypertension in left heart disease. Ther Adv Cardiovasc Dis. 2013; 7(3): 131–151.
  3. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37(1): 67–119.
  4. Hoeper MM, Bogaard HJ, Condliffe R, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol. 2013; 62(25 Suppl): D42–D50.
  5. Miller WL, Grill DE, Borlaug BA. Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: pulmonary hypertension and heart failure. JACC Heart Fail. 2013; 1(4): 290–299.
  6. Gabbay E, Yeow W, Playford D. Pulmonary arterial hypertension is an uncommon cause of pulmonary hypertension in an unselected population: the Armadale echocardiography study. Am J Resp Crit Care Med. 2007; 175: A713.
  7. Tatebe S, Fukumoto Y, Sugimura K, et al. Clinical significance of reactive post-capillary pulmonary hypertension in patients with left heart disease. Circ J. 2012; 76(5): 1235–1244.
  8. Rosenkranz S. Pulmonary hypertension 2015: current definitions, terminology, and novel treatment options. Clin Res Cardiol. 2015; 104(3): 197–207.
  9. Vachiéry JL, Adir Y, Barberà JA, et al. Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol. 2013; 62(25 Suppl): D100–D108.
  10. Gerges C, Gerges M, Lang MB, et al. Diastolic pulmonary vascular pressure gradient: a predictor of prognosis in "out-of-proportion" pulmonary hypertension. Chest. 2013; 143(3): 758–766.
  11. Bursi F, McNallan SM, Redfield MM, et al. Pulmonary pressures and death in heart failure: a community study. J Am Coll Cardiol. 2012; 59(3): 222–231.
  12. Melenovsky V, Hwang SJ, Redfield MM, et al. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015; 8(2): 295–303.
  13. Chen Y, Guo H, Xu D, et al. Left ventricular failure produces profound lung remodeling and pulmonary hypertension in mice: heart failure causes severe lung disease. Hypertension. 2012; 59(6): 1170–1178.
  14. Rosenkranz S, Gibbs JS, Wachter R, et al. Left ventricular heart failure and pulmonary hypertension. Eur Heart J. 2016; 37(12): 942–954.
  15. Melenovsky V, Hwang SJ, Lin G, et al. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014; 35(48): 3452–3462.
  16. Al-Naamani N, Preston IR, Paulus JK, et al. Pulmonary Arterial Capacitance Is an Important Predictor of Mortality in Heart Failure With a Preserved Ejection Fraction. JACC Heart Fail. 2015; 3(6): 467–474.
  17. Shin JT, Semigran MJ. Heart failure and pulmonary hypertension. Heart Fail Clin. 2010; 6(2): 215–222.
  18. Thenappan T, Shah SJ, Gomberg-Maitland M, et al. Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2011; 4(3): 257–265.
  19. Ghio S, Temporelli PL, Klersy C, et al. Prognostic relevance of a non-invasive evaluation of right ventricular function and pulmonary artery pressure in patients with chronic heart failure. Eur J Heart Fail. 2013; 15(4): 408–414.
  20. Hoeper MM, Lee SH, Voswinckel R, et al. Complications of right heart catheterization procedures in patients with pulmonary hypertension in experienced centers. J Am Coll Cardiol. 2006; 48(12): 2546–2552.
  21. Drazner MH, Velez-Martinez M, Ayers CR, et al. Relationship of right- to left-sided ventricular filling pressures in advanced heart failure: insights from the ESCAPE trial. Circ Heart Fail. 2013; 6(2): 264–270.
  22. Ryan JJ, Rich JD, Thiruvoipati T, et al. Current practice for determining pulmonary capillary wedge pressure predisposes to serious errors in the classification of patients with pulmonary hypertension. Am Heart J. 2012; 163(4): 589–594.
  23. LeVarge BL, Pomerantsev E, Channick RN. Reliance on end-expiratory wedge pressure leads to misclassification of pulmonary hypertension. Eur Respir J. 2014; 44(2): 425–434.
  24. Boerrigter BG, Waxman AB, Westerhof N, et al. Measuring central pulmonary pressures during exercise in COPD: how to cope with respiratory effects. Eur Respir J. 2014; 43(5): 1316–1325.
  25. Ryan JJ, Rich JD, Thiruvoipati T, et al. Current practice for determining pulmonary capillary wedge pressure predisposes to serious errors in the classification of patients with pulmonary hypertension. Am Heart J. 2012; 163(4): 589–594.
  26. Konopka M, Braksator W. Nadciśnienie płucne — postępy w diagnostyce i leczeniu. Fam Med Primary Care Rev. 2013; 15(4): 561–566.
  27. Rosenkranz S, Bonderman D, Buerke M, et al. Pulmonary hypertension due to left heart disease: updated Recommendations of the Cologne Consensus Conference 2011. Int J Cardiol. 2011; 154 Suppl 1: S34–S44.
  28. Kutty RS, Parameshwar J, Lewis C, et al. Use of centrifugal left ventricular assist device as a bridge to candidacy in severe heart failure with secondary pulmonary hypertension. Eur J Cardiothorac Surg. 2013; 43(6): 1237–1242.
  29. Kalogeropoulos AP, Georgiopoulou VV, Borlaug BA, et al. Left ventricular dysfunction with pulmonary hypertension: part 2: prognosis, noninvasive evaluation, treatment, and future research. Circ Heart Fail. 2013; 6(3): 584–593.
  30. Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery hemodynamic monitoring in chronic heart failure: a randomized controlled trial. Lancet. 2011; 377: 658–666.
  31. Haddad F, Kudelko K, Mercier O, et al. Pulmonary hypertension associated with left heart disease: characteristics, emerging concepts, and treatment strategies. Prog Cardiovasc Dis. 2011; 54(2): 154–167.
  32. Kieler-Jensen N, Lundin S, Ricksten SE. Vasodilator therapy after heart transplantation: effects of inhaled nitric oxide and intravenous prostacyclin, prostaglandin E1, and sodium nitroprusside. J Heart Lung Transplant. 1995; 14(3): 436–443.
  33. Matamis D, Pampori S, Papathanasiou A, et al. Inhaled NO and sildenafil combination in cardiac surgery patients with out-of-proportion pulmonary hypertension: acute effects on postoperative gas exchange and hemodynamics. Circ Heart Fail. 2012; 5(1): 47–53.
  34. Sueta CA, Gheorghiade M, Adams KF, et al. Safety and efficacy of epoprostenol in patients with severe congestive heart failure. Epoprostenol Multicenter Research Group. Am J Cardiol. 1995; 75(3): 34A–43A.
  35. Shah MR, Stinnett SS, McNulty SE, et al. Hemodynamics as surrogate end points for survival in advanced heart failure: an analysis from FIRST. Am Heart J. 2001; 141(6): 908–914.
  36. Sütsch G, Kiowski W, Yan XW, et al. Short-term oral endothelin-receptor antagonist therapy in conventionally treated patients with symptomatic severe chronic heart failure. Circulation. 1998; 98(21): 2262–2268.
  37. Hefke T, Zittermann A, Fuchs U, et al. Bosentan effects on hemodynamics and clinical outcome in heart failure patients with pulmonary hypertension awaiting cardiac transplantation. Thorac Cardiovasc Surg. 2012; 60(1): 26–34.
  38. Guazzi M, Vicenzi M, Arena R, et al. Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study. Circulation. 2011; 124(2): 164–174.
  39. Di Salvo TG. Pulmonary hypertension and right ventricular failure in left ventricular systolic dysfunction. Curr Opin Cardiol. 2012; 27(3): 262–272.
  40. Borlaug BA, Lewis GD, McNulty SE, et al. Effects of sildenafil on ventricular and vascular function in heart failure with preserved ejection fraction. Circ Heart Fail. 2015; 8(3): 533–541.
  41. Wu X, Yang Te, Zhou Qi, et al. Additional use of a phosphodiesterase 5 inhibitor in patients with pulmonary hypertension secondary to chronic systolic heart failure: a meta-analysis. Eur J Heart Fail. 2014; 16(4): 444–453.
  42. Cooper TJ, Guazzi M, Al-Mohammad A, et al. Sildenafil in Heart failure (SilHF). An investigator-initiated multinational randomized controlled clinical trial: rationale and design. Eur J Heart Fail. 2013; 15(1): 119–122.
  43. Bonderman D, Ghio S, Felix SB, et al. Left Ventricular Systolic Dysfunction Associated With Pulmonary Hypertension Riociguat Trial (LEPHT) Study Group. Riociguat for patients with pulmonary hypertension caused by systolic left ventricular dysfunction: a phase IIb double-blind, randomized, placebo-controlled, dose-ranging hemodynamic study. Circulation. 2013; 128(5): 502–511.
  44. Bonderman D, Pretsch I, Steringer-Mascherbauer R, et al. Acute hemodynamic effects of riociguat in patients with pulmonary hypertension associated with diastolic heart failure (DILATE-1): a randomized, double-blind, placebo-controlled, single-dose study. Chest. 2014; 146(5): 1274–1285.
  45. Lancellotti P, Magne J, Dulgheru R, et al. Clinical significance of exercise pulmonary hypertension in secondary mitral regurgitation. Am J Cardiol. 2015; 115: 1554–1561.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl