Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filli...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2024-02-01
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| Series: | European Respiratory Review |
| Online Access: | http://err.ersjournals.com/content/33/171/230144.full |
| _version_ | 1827293549577633792 |
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| author | Marielle C. van de Veerdonk Lize Roosma Pia Trip Deepa Gopalan Anton Vonk Noordegraaf Peter Dorfmüller Esther J. Nossent |
| author_facet | Marielle C. van de Veerdonk Lize Roosma Pia Trip Deepa Gopalan Anton Vonk Noordegraaf Peter Dorfmüller Esther J. Nossent |
| author_sort | Marielle C. van de Veerdonk |
| collection | DOAJ |
| description | Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases. |
| first_indexed | 2024-04-24T13:40:58Z |
| format | Article |
| id | doaj.art-b7c58598f6664e63b343dc3efdd2976f |
| institution | Directory Open Access Journal |
| issn | 0905-9180 1600-0617 |
| language | English |
| last_indexed | 2024-04-24T13:40:58Z |
| publishDate | 2024-02-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | European Respiratory Review |
| spelling | doaj.art-b7c58598f6664e63b343dc3efdd2976f2024-04-04T08:47:47ZengEuropean Respiratory SocietyEuropean Respiratory Review0905-91801600-06172024-02-013317110.1183/16000617.0144-20230144-2023Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart diseaseMarielle C. van de Veerdonk0Lize Roosma1Pia Trip2Deepa Gopalan3Anton Vonk Noordegraaf4Peter Dorfmüller5Esther J. Nossent6 Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands Department of Radiology, Imperial College Hospital NHS Trust, London, UK Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.http://err.ersjournals.com/content/33/171/230144.full |
| spellingShingle | Marielle C. van de Veerdonk Lize Roosma Pia Trip Deepa Gopalan Anton Vonk Noordegraaf Peter Dorfmüller Esther J. Nossent Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease European Respiratory Review |
| title | Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease |
| title_full | Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease |
| title_fullStr | Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease |
| title_full_unstemmed | Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease |
| title_short | Clinical–imaging–pathological correlation in pulmonary hypertension associated with left heart disease |
| title_sort | clinical imaging pathological correlation in pulmonary hypertension associated with left heart disease |
| url | http://err.ersjournals.com/content/33/171/230144.full |
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