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

  • Updates in Advanced Heart Failure (E. Rame and M. St. John Sutton, Section Editors)
  • Published:
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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.

Summary

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.

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Authors and Affiliations

  1. Advanced Heart Failure/Transplantation Program, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Sriram D. Rao, Edo Y. Birati & Jeremy A. Mazurek

  2. Advanced Heart Failure and Cardiac Transplant Program, Advanced Congenital Cardiac Therapies, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Jonathan N. Menachem

  3. Pulmonary Hypertension Program, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Jeremy A. Mazurek

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Sriram D. Rao and Jonathan N. Menachem declare no conflict of interest. Dr. Birati reports personal fees from Luitpold Pharmaceuticals, Inc. Dr. Mazurek reports personal fees from Actelion Pharmaceuticals.

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Rao, S.D., Menachem, J.N., Birati, E.Y. et al. Pulmonary Hypertension in Advanced Heart Failure: Assessment and Management of the Failing RV and LV. Curr Heart Fail Rep 16, 119–129 (2019). https://doi.org/10.1007/s11897-019-00431-4

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