title: Pulmonary hypertension and right ventricular failure in left ventricular systolic dysfunction.
abstract: OBJECTIVE
  Pulmonary hypertension and right ventricular failure (RVF) in left ventricular systolic dysfunction (LVSD) is associated with high morbidity and mortality. This review presents an overview of the classification, pathophysiology, natural history, clinical features, prevention and treatment of this common clinical problem with a focus on the most recent studies. Many of the current evidence-based therapeutic agents for pulmonary hypertension in the absence of systolic or diastolic heart failure (e.g. prostaglandins, endothelin antagonists) are not efficacious in pulmonary hypertension with LVSD.
  
  
  RESULTS
  Recent clinical evidence strongly supports an evolving role for phosphodiesterase type 5 (PDE5) inhibition in patients with pulmonary hypertension and LVSD. Chronic PDE5 inhibition in the short-to-intermediate duration studies to date significantly reduces pulmonary pressures and pulmonary vascular resistance (PVR), effects reverse right ventricle and left ventricle remodeling, improves ventilator efficiency, improves peak exercise capacity and improves quality of life in selected patients with stable, moderately symptomatic LVSD and pulmonary hypertension.
  
  
  CONCLUSIONS
  Although long-term outcome studies are currently lacking, chronic PDE5 inhibition should be considered in carefully selected LVSD patients who manifest persistent significant elevation of pulmonary hypertension or PVR or uncontrolled RVF after aggressive management with all standard current evidence-based LVSD therapies (neurohormonal antagonists, diuretics and cardiac resynchronization in appropriate candidates).
authors.affiliation: Advanced Heart Failure Program, Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. thomas.g.disalvo@vanderbilt.edu
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Di Salvo
mesh_terms: D017079:Exercise Tolerance; D006333:Heart Failure / Q000209:etiology* / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012307:Risk Factors; D013599:Systole; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
chemical_list: D058986:Phosphodiesterase 5 Inhibitors