Secondary pulmonary hypertension in chronic heart failure: the role of the endothelium in pathophysiology and management.
Pulmonary vascular resistance is frequently elevated in patients with chronic left ventricular failure as a result of dysregulation of vascular smooth muscle tone and structural remodeling. The former is reversible over a period of minutes to days by pharmacological vasodilators, whereas the latter is relatively fixed and may resolve only slowly, over months to years. These abnormalities are due, at least in part, to pulmonary vascular endothelial dysfunction that results in impaired nitric oxide availability and increased endothelin expression. In patients with chronic heart failure, the resulting pulmonary hypertension directly affects right ventricular function and may affect exercise capacity, morbidity, and mortality. New treatment strategies, which include the use of agents that increase nitric oxide availability or oppose the actions of endothelin, may improve the structure and function of the pulmonary vasculature in patients with chronic heart failure.
Moraes
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DL
Cardiovascular Section, Boston University Medical Center, Boston, MA 02118, USA.
Colucci
W S
WS
Givertz
M M
MM
D000959:Antihypertensive Agents / Q000627:therapeutic use; D002303:Cardiac Output, Low / Q000150:complications*; D002908:Chronic Disease; D065128:Endothelin Receptor Antagonists; D016232:Endothelins / Q000378:metabolism; D004730:Endothelium, Vascular / Q000473:pathology / Q000502:physiology*; D015444:Exercise / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000401:mortality; D009569:Nitric Oxide / Q000378:metabolism* / Q000627:therapeutic use; D014655:Vascular Resistance; D014664:Vasodilation; D018487:Ventricular Dysfunction, Left / Q000150:complications*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
D000959:Antihypertensive Agents; D065128:Endothelin Receptor Antagonists; D016232:Endothelins; D009569:Nitric Oxide