title: Management of pulmonary hypertension in left heart disease.
abstract: Pulmonary hypertension (PH) due to left heart disease is classified as group II according to the Dana Point classification, which includes left ventricular systolic and/or diastolic left heart failure, and left-sided valvular disease. PH due to left heart disease is the most common cause and when present, especially with right ventricular dysfunction, is associated with a worse prognosis. Left heart disease with secondary PH is associated with increased left atrial pressure, which causes a passive increase in pulmonary pressure. Passive PH could be superimposed by an active protective, and in some patients by an 'out of proportion', elevated precapillary pulmonary vasoconstriction and vascular remodelling which leads to greater or lesser further increase of the pulmonary artery pressure. In this review, epidemiological and pathophysiologic mechanisms for the development of group II PH are summarized. The conflicting data about the haemodynamic and possible parameters to diagnose passive versus reactive and 'out of proportion' PH are presented. The different therapeutic concepts, along with novel treatment strategies, are reviewed in detail and critically discussed regarding their effectiveness and safety.
authors.affiliation: Internal Medicine/Cardiology, Angiology and Pneumology, Magdeburg University, Leipziger Str.44, 39120 Magdeburg, Germany. Alexander.Schmeisser@med.ovgu.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Schmeisser
authors.forename: Hagen
authors.initials: H
authors.lastname: Schroetter
authors.forename: Ruediger C
authors.initials: RC
authors.lastname: Braun-Dulleaus
mesh_terms: D000818:Animals; D006331:Heart Diseases / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D014661:Vasoconstriction; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
keywords: management; post-capillary pulmonary hypertension; pulmonary hypertension due to left heart disease; transpulmonary gradient