PDF icon Download PDF
Semin Respir Crit Care Med 2013; 34(05): 665-680
DOI: 10.1055/s-0033-1356490
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Hypertension Associated with Left Heart Disease

Yochai Adir
1   Division of Pulmonary, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion, Institute of Technology, Haifa, Israel
,
Offer Amir
2   Department of Cardiology, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion, Institute of Technology, Haifa, Israel
› Author Affiliations
Further Information

Publication History

Publication Date:
13 September 2013 (online)

   Permissions and Reprints
Preview

Abstract

Left heart disease (LHD) is probably the most frequent cause of pulmonary hypertension (PH). Although rheumatic mitral valve stenosis has been in the past the most common cause of this condition, PH-LHD mainly results from heart failure related to systolic and/or diastolic dysfunction of the left ventricle and is associated with elevated left-sided cardiac filling pressures. Most patients have passive increase in pulmonary arterial pressure because of backward transmission of the elevated left atrial pressure, whereas a small subset develop severe PH with elevated transpulmonary gradient and pulmonary vascular resistance. When present, PH is usually associated with a poor prognosis and increased mortality. Optimizing heart failure regimens and corrective valve surgery are the cornerstones of the treatment of PH in LHD. Although PH-LHD may evolve to right ventricular failure and is associated with some changes in the pulmonary vascular bed similar to pulmonary arterial hypertension (PAH), there is no evidence-based data to support the use of PAH-specific therapies in the setting of PH-LHD. However, recent studies suggest the usefulness of sildenafil, a phosphodiesterase-5 inhibitor. This review addresses the epidemiology, pathophysiology, risk factors, and treatment controversies of PH due to LHDs.

Keywords

heart failure - left heart disease - pulmonary hypertension - valvular disease