title: Pulmonary hypertension associated with left heart disease: characteristics, emerging concepts, and treatment strategies.
abstract: Left heart disease (LHD) represents the most common causes of pulmonary hypertension (PH). Whether caused by systolic or diastolic dysfunction or valvular heart disease, a hallmark of PH associated with LHD is elevated left atrial pressure. In all cases, the increase in left atrial pressure causes a passive increase in pulmonary pressure. In some patients, a superimposed active component caused by pulmonary arterial vasoconstriction and vascular remodeling may lead to a further increase in pulmonary arterial pressure. When present, PH is associated with a worse prognosis in patients with LHD. In addition to local abnormalities in nitric oxide and endothelin production, gene modifiers such as serotonin polymorphisms may be associated with the pathogenesis of PH in LHD. Optimizing heart failure regimens and corrective valve surgery represent the cornerstone of the treatment of PH in LHD. Recent studies suggest that sildenafil, a phosphodiesterase-5 inhibitor, is a promising agent in the treatment of PH in LHD. Unloading the left ventricle with circulatory support may also reverse severe PH in patients with end-stage heart failure allowing candidacy to heart transplantation.
authors.affiliation: Division of Cardiovascular Medicine, Stanford School of Medicine, CA 94305, USA. fhaddad@stanford.edu
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.forename: Kristina
authors.initials: K
authors.lastname: Kudelko
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
authors.forename: Roham T
authors.initials: RT
authors.lastname: Zamanian
authors.forename: Vinicio
authors.initials: V
authors.lastname: de Jesus Perez
mesh_terms: D016275:Atrial Function; D020022:Genetic Predisposition to Disease; D006333:Heart Failure / Q000150:complications* / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016277:Ventricular Function, Left