Pulmonary Hypertension in Advanced Heart Failure: Assessment and Management of the Failing RV and LV

Curr Heart Fail Rep. 2019 Oct;16(5):119-129. doi: 10.1007/s11897-019-00431-4.

Abstract

Purpose of review: In patients with heart failure with reduced ejection fraction, the presence of pulmonary hypertension (PH-LHD) has a significant impact on their prognosis. The purpose of this review is to explain the methods of diagnosing PH-LHD and then discuss the available therapeutic options.

Recent findings: We begin by examining the methods of assessment of PH-LHD-echocardiography, cardiopulmonary exercise testing, and right heart catheterization-with a particular focus on the importance of accurate measurement to ensure the proper determination of PH-LHD. We then focus primarily on management of PH-LHD, with an examination of trials of therapeutic options, use of mechanical circulatory support, and transplantation. This review highlights the complexities in diagnosis and management of PH-LHD. We outline a number of useful ways to maximize the yield of diagnostic testing, as well as give suggestions on the use of medical therapies, the role of both temporary mechanical support and left ventricular assist device, and finally the ways to best bridge these patients to transplantation.

Keywords: Heart failure; Post capillary; Pulmonary hypertension; Ventricular dysfunction, left; Ventricular dysfunction, right.

Publication types

  • Review

MeSH terms

  • Disease Management
  • Echocardiography
  • Exercise Test
  • Heart Failure / complications*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Humans
  • Hypertension, Pulmonary / diagnosis*
  • Hypertension, Pulmonary / epidemiology
  • Hypertension, Pulmonary / etiology*
  • Hypertension, Pulmonary / therapy
  • Prognosis
  • Stroke Volume
  • Ventricular Dysfunction, Left / complications*
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Right / complications*
  • Ventricular Dysfunction, Right / diagnostic imaging