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Treatment for Pulmonary Hypertension of Left Heart Disease

  • Marco GuazziEmail author
  • Alessandra Vitelli
  • Valentina Labate
  • Ross Arena
Heart Failure (J Fang, Section Editor)

Opinion statement

Pulmonary hypertension (PH) secondary to left heart disease is a largely underestimated target of therapy. Except for a specific focus on PH consequences in patients with advanced heart failure (HF) receiving a left ventricular mechanical assist device or candidates for transplantation, prevention and treatment of initial subclinical forms of PH are not considered a priority in the management of this chronic disease population. Nonetheless, there is recent growing evidence supporting a clinical and prognostic role of PH in the elderly and in HF with preserved ejection fraction (pEF). Studies have defined PH-HFpEF as a new entity typically defining the evolving nature of disease. Although the prevalence of PH in these populations is not well-defined, the potential for effective pharmacological approaches that might impact the natural history of the disease starting from earlier stages is promising. However, it should be recognized that pharmacological studies performed to date with traditional pulmonary vasodilators in cohorts with HF and left-sided PH have not been positive, primarily because of concomitant systemic hypotension and hepatic side effects. This evidence along with the lack of studies specifically performed in the elderly and HFpEF often lead Guidelines to give neutral recommendations or even arbitrary assumptions. Recent availability of selective well-tolerated pulmonary vasodilators, such as phosphodiesterase type 5 (PDE5) inhibitors, however, seem to offer a solid background for treating left-sided PH at both early and later stages of the disease process.

Keywords

Pulmonary hypertension Heart failure Pulmonary vasodilators Prostaglandins Endothelin-1 receptor blockers Nitric oxide PDE-5 inhibitors Cardiac resynchronization therapy LV assist devices 

Notes

Acknowledgments

This work was supported by a grant from the Monzino Foundation, Milano, Italy.

Disclosures

No potential conflicts of interest relevant to this article were reported.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Marco Guazzi
    • 1
    Email author
  • Alessandra Vitelli
    • 2
  • Valentina Labate
    • 1
  • Ross Arena
    • 3
  1. 1.Cardiopulmonary UnitUniversity of Milano, I.R.C.C.S, Policlinico San DonatoMilanoItaly
  2. 2.Rehabilitation UnitFederico II UniversityNaplesItaly
  3. 3.Physical Therapy Program, Department of Orthopaedics and Division of Cardiology, Department of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueUSA

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