Pulmonary hypertension and right heart failure in heart failure with preserved left ventricular ejection fraction:  pathophysiology and natural history.
OBJECTIVE
Pulmonary hypertension and right heart failure are common findings in patients suffering from heart failure with preserved ejection fraction (HFpEF). In this review, we summarize our current understanding of the pathophysiology of pulmonary hypertension related to heart failure.


RESULTS
HFpEF is a clinical syndrome with increasing prevalence and a mortality rate similar to heart failure with reduced ejection fraction. Because the pathophysiology and even the definition of this disease are still controversial, we will first outline the current conceptual framework around heart failure with preserved ejection fraction. Next, we will outline our current knowledge on the pathophysiology of pulmonary hypertension related to left ventricular failure and diastolic dysfunction. Diastolic dysfunction induces pulmonary hypertension through passive transmission of elevated end diastolic pressures, reactive pulmonary vasoconstriction, and vascular remodeling. Eventually, right ventricular failure develops that can further potentiate left ventricular failure because of their close mechanical, cellular, and biochemical integration.


CONCLUSIONS
Exciting new studies have led to an increased understanding of the underlying pathophysiology and indicate that pulmonary hypertension in heart failure may be treatable.
University of Antwerp, Laboratory of Physiology and Pharmacology, Antwerp, Belgium.
Vincent F M
VF
Segers
Dirk L
DL
Brutsaert
Gilles W
GW
De Keulenaer
D003971:Diastole; D018450:Disease Progression; D006333:Heart Failure / Q000473:pathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000473:pathology*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D014661:Vasoconstriction; D016277:Ventricular Function, Left