Rosenkranz, S., Kramer, T., Gerhardt, F., Opitz, C., Olsson, K. M. and Hoeper, M. M. (2019). Pulmonary hypertension in HFpEF and HFrEF: Pathophysiology, diagnosis, treatment approaches. Herz, 44 (6). S. 483 - 491. MUNICH: URBAN & VOGEL. ISSN 1615-6692

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Abstract

Pulmonary hypertension (PH) is a frequent hemodynamic condition that is highly prevalent in patients with heart failure and reduced (HFrEF) or preserved ejection fraction (HFpEF). Irrespective of left ventricular EF, the presence of PH and right ventricular (RV) dysfunction are highly relevant for morbidity and mortality in patients with heart failure. While elevated left-sided filling pressures and functional mitral regurgitation primarily lead to post-capillary PH, current guidelines and recommendations distinguish between isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH), the latter being defined by a pulmonary vascular resistance (PVR) of >= 3 Wood units. Here, we describe the pathophysiology and clinical relevance of these distinct entities, and report on the diagnostic work-up including remote pulmonary artery pressure (PAP) monitoring. Furthermore, we highlight strategies to manage PH and improve RV function in heart failure, which may include optimized management of HFrEF and HFpEF (medical and interventional), sufficient volume control, catheter-based mitral valve repair, and-in selected cases-targeted PH therapy. In this context, we also highlight gaps in evidence and the need for further research.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Rosenkranz, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kramer, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerhardt, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Opitz, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Olsson, K. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoeper, M. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-142930
DOI: 10.1007/s00059-019-4831-6
Journal or Publication Title: Herz
Volume: 44
Number: 6
Page Range: S. 483 - 491
Date: 2019
Publisher: URBAN & VOGEL
Place of Publication: MUNICH
ISSN: 1615-6692
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
PRESERVED EJECTION FRACTION; CHRONIC HEART-FAILURE; VENTRICULAR ASSIST DEVICES; ARTERY PRESSURE; PHOSPHODIESTERASE-5 INHIBITION; EXERCISE CAPACITY; PRE-CAPILLARY; DYSFUNCTION; SILDENAFIL; HEMODYNAMICSMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/14293

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