Post-Capillary Pulmonary Hypertension: Clinical Review
Pulmonary hypertension (PH) caused by left heart disease, also known as post-capillary PH, is the most common etiology of PH. Left heart disease due to systolic dysfunction or heart failure with preserved ejection fraction, valvular heart disease, and left atrial myopathy due to atrial fibrillation...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-01-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/13/2/625 |
| _version_ | 1797339656744861696 |
|---|---|
| author | Joshua M. Riley James J. Fradin Douglas H. Russ Eric D. Warner Yevgeniy Brailovsky Indranee Rajapreyar |
| author_facet | Joshua M. Riley James J. Fradin Douglas H. Russ Eric D. Warner Yevgeniy Brailovsky Indranee Rajapreyar |
| author_sort | Joshua M. Riley |
| collection | DOAJ |
| description | Pulmonary hypertension (PH) caused by left heart disease, also known as post-capillary PH, is the most common etiology of PH. Left heart disease due to systolic dysfunction or heart failure with preserved ejection fraction, valvular heart disease, and left atrial myopathy due to atrial fibrillation are causes of post-capillary PH. Elevated left-sided filling pressures cause pulmonary venous congestion due to backward transmission of pressures and post-capillary PH. In advanced left-sided heart disease or valvular heart disease, chronic uncontrolled venous congestion may lead to remodeling of the pulmonary arterial system, causing combined pre-capillary and post-capillary PH. The hemodynamic definition of post-capillary PH includes a mean pulmonary arterial pressure > 20 mmHg, pulmonary vascular resistance < 3 Wood units, and pulmonary capillary wedge pressure > 15 mmHg. Echocardiography is important in the identification and management of the underlying cause of post-capillary PH. Management of post-capillary PH is focused on the treatment of the underlying condition. Strategies are geared towards pharmacotherapy and guideline-directed medical therapy for heart failure, surgical or percutaneous management of valvular disorders, and control of modifiable risk factors and comorbid conditions. Referral to centers with advanced heart and pulmonary teams has shown to improve morbidity and mortality. There is emerging interest in the use of targeted agents classically used in pulmonary arterial hypertension, but current data remain limited and conflicting. This review aims to serve as a comprehensive summary of postcapillary PH and its etiologies, pathophysiology, diagnosis, and management, particularly as it pertains to advanced heart failure. |
| first_indexed | 2024-03-08T09:50:26Z |
| format | Article |
| id | doaj.art-0863fde35b744656965a17a6292104bf |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T09:50:26Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0863fde35b744656965a17a6292104bf2024-01-29T14:03:53ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113262510.3390/jcm13020625Post-Capillary Pulmonary Hypertension: Clinical ReviewJoshua M. Riley0James J. Fradin1Douglas H. Russ2Eric D. Warner3Yevgeniy Brailovsky4Indranee Rajapreyar5Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USASidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19147, USADepartment of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USADepartment of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USAJefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USAJefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA 19147, USAPulmonary hypertension (PH) caused by left heart disease, also known as post-capillary PH, is the most common etiology of PH. Left heart disease due to systolic dysfunction or heart failure with preserved ejection fraction, valvular heart disease, and left atrial myopathy due to atrial fibrillation are causes of post-capillary PH. Elevated left-sided filling pressures cause pulmonary venous congestion due to backward transmission of pressures and post-capillary PH. In advanced left-sided heart disease or valvular heart disease, chronic uncontrolled venous congestion may lead to remodeling of the pulmonary arterial system, causing combined pre-capillary and post-capillary PH. The hemodynamic definition of post-capillary PH includes a mean pulmonary arterial pressure > 20 mmHg, pulmonary vascular resistance < 3 Wood units, and pulmonary capillary wedge pressure > 15 mmHg. Echocardiography is important in the identification and management of the underlying cause of post-capillary PH. Management of post-capillary PH is focused on the treatment of the underlying condition. Strategies are geared towards pharmacotherapy and guideline-directed medical therapy for heart failure, surgical or percutaneous management of valvular disorders, and control of modifiable risk factors and comorbid conditions. Referral to centers with advanced heart and pulmonary teams has shown to improve morbidity and mortality. There is emerging interest in the use of targeted agents classically used in pulmonary arterial hypertension, but current data remain limited and conflicting. This review aims to serve as a comprehensive summary of postcapillary PH and its etiologies, pathophysiology, diagnosis, and management, particularly as it pertains to advanced heart failure.https://www.mdpi.com/2077-0383/13/2/625pulmonary hypertensionpost-capillaryheart failureadvanced heart failureHFrEF |
| spellingShingle | Joshua M. Riley James J. Fradin Douglas H. Russ Eric D. Warner Yevgeniy Brailovsky Indranee Rajapreyar Post-Capillary Pulmonary Hypertension: Clinical Review Journal of Clinical Medicine pulmonary hypertension post-capillary heart failure advanced heart failure HFrEF |
| title | Post-Capillary Pulmonary Hypertension: Clinical Review |
| title_full | Post-Capillary Pulmonary Hypertension: Clinical Review |
| title_fullStr | Post-Capillary Pulmonary Hypertension: Clinical Review |
| title_full_unstemmed | Post-Capillary Pulmonary Hypertension: Clinical Review |
| title_short | Post-Capillary Pulmonary Hypertension: Clinical Review |
| title_sort | post capillary pulmonary hypertension clinical review |
| topic | pulmonary hypertension post-capillary heart failure advanced heart failure HFrEF |
| url | https://www.mdpi.com/2077-0383/13/2/625 |
| work_keys_str_mv | AT joshuamriley postcapillarypulmonaryhypertensionclinicalreview AT jamesjfradin postcapillarypulmonaryhypertensionclinicalreview AT douglashruss postcapillarypulmonaryhypertensionclinicalreview AT ericdwarner postcapillarypulmonaryhypertensionclinicalreview AT yevgeniybrailovsky postcapillarypulmonaryhypertensionclinicalreview AT indraneerajapreyar postcapillarypulmonaryhypertensionclinicalreview |