[Pulmonary hypertension associated with left heart disease (group 2)].

Patients with left heart disease (LHD) often display pulmonary hypertension (PH), which impacts morbidity and mortality. The pathophysiology of PH is complex and entails pulmonary congestion due to elevated left-sided filling pressures, pulmonary vasoconstriction as well as vascular remodeling. The recent ESC/ERS Guidelines on pulmonary hypertension updated the hemodynamic definitions of pulmonary hypertension in general, and the subclassification of post-capillary PH. This review summarizes recent advances in the diagnostic work-up and management strategies of PH associated with LHD. Specifically, we summarize revisited hemodynamic definitions and the characteristics of isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH). Furthermore, we review the current knowledge on the pathogenesis of PH-LHD, the prognostic relevance of hemodynamic parameters, and the management strategies, differentiating between treatment of the underlying left heart disease and therapies targeting the pulmonary circulation. The article emphasises the need for precise diagnostic work-up and individualized treatment strategies in patients with PH-LHD.

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Déclaration de conflit d'intérêts

MW: Vortragshonorare von Janssen; JA: Vortragshonorare von Janssen und MSD; CH: Honorare für Vorträge und/oder Beratertätigkeiten: Actelion, Bayer, MSD, Pfizer; SR: Honorare für Vorträge und/oder Beratertätigkeiten: Abbott, Acceleron, Actelion, Aerovate, Altavant, AOP Orphan, AstraZeneca, Bayer, Boehringer-Ingelheim, Edwards, Ferrer, Gossamer, Janssen, MSD, United Therapeutics, Vifor; Forschungsunterstützung an Institution: Actelion, AstraZeneca, Bayer, Janssen; JD, LO, TT und SB: keine Interessenkonflikte im Zusammenhang mit diesem Artikel.