Universität zu Köln

Rosenkranz, Stephan, Gibbs, J. Simon R., Wachter, Rolf ORCID: 0000-0003-2231-2200, De Marco, Teresa, Vonk-Noordegraaf, Anton and Vachiery, Jean-Luc (2016). Left ventricular heart failure and pulmonary hypertension. Eur. Heart J., 37 (12). S. 942 - 957. OXFORD: OXFORD UNIV PRESS. ISSN 1522-9645

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Abstract

In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65-80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a 'left ventricular phenotype' to a 'right ventricular phenotype' across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rosenkranz, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Gibbs, J. Simon R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wachter, Rolf UNSPECIFIED orcid.org/0000-0003-2231-2200 UNSPECIFIED De Marco, Teresa UNSPECIFIED UNSPECIFIED UNSPECIFIED Vonk-Noordegraaf, Anton UNSPECIFIED UNSPECIFIED UNSPECIFIED Vachiery, Jean-Luc UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-281125
DOI:	10.1093/eurheartj/ehv512
Journal or Publication Title:	Eur. Heart J.
Volume:	37
Number:	12
Page Range:	S. 942 - 957
Date:	2016
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1522-9645
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PRESERVED EJECTION FRACTION; CAPILLARY WEDGE PRESSURE; ARTERY PRESSURE; PHOSPHODIESTERASE-5 INHIBITION; INTERNATIONAL SOCIETY; EXERCISE CAPACITY; PROGNOSTIC VALUE; DYSFUNCTION; DIAGNOSIS; GRADIENT Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28112