Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction

  title={Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction},
  author={Debra D Dixon and Amar Trivedi and Sanjiv J. Shah},
  journal={Heart Failure Reviews},
Over 2.5 million patients in the USA suffer from heart failure with preserved ejection fraction (HFpEF), and pulmonary hypertension (PH) is present in the majority of these patients. PH represents an adverse prognostic factor in HFpEF and has been identified as a potential therapeutic target to improve symptoms and outcomes. The recognition and investigation of a subset of patients with superimposed pulmonary vascular disease (on top of pulmonary venous hypertension) has led to further… 
Combined pre- and post-capillary pulmonary hypertension in left heart disease
It may be hypothesized to treat patients in whom the pre-capillary component is predominant with specific therapies such as those for idiopathic pulmonary arterial hypertension; however, no adequately powered trials of PH-specific treatment are available in combined PH.
Structural and Hemodynamic Changes of the Right Ventricle in PH-HFpEF
A better understanding of pathobiological processes underneath PH-HFpEF, and the identification of potential maladaptive RV mechanisms with an appropriate diagnostic tool, become mandatory in order to distinguish and manage these two similar forms of pulmonary hypertension.
Right ventricular-vascular coupling in heart failure with preserved ejection fraction and pre- vs. post-capillary pulmonary hypertension
Abnormal right ventricular-vascular coupling identifies patients withHFpEF and additional pre-capillary PH, and predicts poor outcome in HFpEF.
Pulmonary arterial hypertension and heart failure with preserved ejection fraction: are they so discordant?
This model suggests HFpEF and PAH as two comparable conditions, with different cardiac adaptation and trajectories, linked to the intrinsic properties of either right and left ventricles.
Metformin Therapy for Pulmonary Hypertension Associated with Heart Failure with Preserved Ejection Fraction versus Pulmonary Arterial Hypertension.
The data showed that metformin treatment failed to reverse pulmonary pressures and vascular remodeling in mice with SuHx-induced PAH, and this finding may have implications for the future treatment of patients with PAH.
Helping to understand heart failure with preserved ejection fraction
A pattern resembling the combination of advanced heart failure as found in IpcPH and pulmonary arterial hypertension (PAH) is found, suggesting that both pathophysiologies contribute to exercise intolerance.
Prognostic Importance of Right Ventricular-Vascular Uncoupling in Acute Decompensated Heart Failure With Preserved Ejection Fraction
Prospective study of a hospitalized cohort revealed that RV-PA uncoupling was independently associated with adverse outcomes in acute decompensated patients with HFpEF.
Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology
The Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF and potential treatment strategies and future directions regarding the right side are discussed.


Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study.
Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival.
Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes in patients with chronic heart failure.
Risk assessment in pulmonary hypertension associated with heart failure and preserved ejection fraction.
Pulmonary hypertension due to left heart diseases.
Prognostic importance of pulmonary hypertension in patients with heart failure.
Pulmonary pressures and death in heart failure: a community study.
[Definitions and diagnosis of pulmonary hypertension].
Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing has a higher predictive value than echocardiography alone.
Management of pulmonary arterial hypertension.