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Maron BA, Bortman G, De Marco T, Huston JH, Lang IM, Rosenkranz SH, Vachiéry JL, Tedford RJ. Pulmonary hypertension associated with left heart disease. Eur Respir J 2024:2401344. [PMID: 39209478 DOI: 10.1183/13993003.01344-2024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH), which may be classified further as isolated post-capillary (ipcPH) or combined post- and pre-capillary PH (cpcPH). The 7th World Symposium on Pulmonary Hypertension PH-LHD task force reviewed newly reported randomised clinical trials and contemplated novel opportunities for improving outcome. Results from major randomised clinical trials reinforced prior recommendations against the use of pulmonary arterial hypertension therapy in PH-LHD outside of clinical trials, and suggested possible harm. Greater focus on phenotyping was viewed as one general strategy by which to ultimately improve clinical outcomes. This is potentially achievable by individualising ipcPH versus cpcPH diagnosis for patients with pulmonary arterial wedge pressure within a diagnostic grey zone (12-18 mmHg), and through a newly developed PH-LHD staging system. In this model, PH accompanies LHD across four stages (A=at risk, B=structural heart disease, C=symptomatic heart disease, D=advanced), with each stage characterised by progression in clinical characteristics, haemodynamics and potential therapeutic strategies. Along these lines, the task force proposed disaggregating PH-LHD to emphasise specific subtypes for which PH prevalence, pathophysiology and treatment are unique. This includes re-interpreting mitral and aortic valve stenosis through a contemporary lens, and focusing on PH within the hypertrophic cardiomyopathy and amyloid cardiomyopathy clinical spectra. Furthermore, appreciating LHD in the profile of PH patients with chronic lung disease and chronic thromboembolic pulmonary disease is essential. However, engaging LHD patients in clinical research more broadly is likely to require novel methodologies such as pragmatic trials and may benefit from next-generation analytics to interpret results.
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Affiliation(s)
- Bradley A Maron
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- The University of Maryland - Institute for Health Computing, Bethesda, MD, USA
| | - Guillermo Bortman
- Transplant Unit, Heart Failure and PH Program, Sanatorio Trinidad Mitre and Sanatorio Trinidad Palermo, Buenos Aires, Argentina
| | - Teresa De Marco
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Irene M Lang
- Medical University of Vienna AUSTRIA Center of Cardiovascular Medicine, Vienna, Austria
| | - Stephan H Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jean-Luc Vachiéry
- HUB (Hopital Universitaire de Bruxelles) Erasme, Free University of Brussels, Brussels, Belgium
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Ilonze OJ, Ebong IA, Guglin M, Nair A, Rich J, McLaughlin V, Tedford RJ, Mazimba S. Considerations in the Diagnosis and Management of Pulmonary Hypertension Associated With Left Heart Disease. JACC. HEART FAILURE 2024; 12:1328-1342. [PMID: 38970588 DOI: 10.1016/j.jchf.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 03/04/2024] [Accepted: 04/08/2024] [Indexed: 07/08/2024]
Abstract
Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies-pharmacologic, device-based, and surgical therapies used for managing PH-LHD-are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.
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Affiliation(s)
- Onyedika J Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA.
| | - Imo A Ebong
- Division of Cardiology, University of California Davis, Sacramento, California, USA
| | - Maya Guglin
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA
| | - Ajith Nair
- Winters Center for Heart Failure Research, Michael E. DeBakey VA Medical Center, Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan Rich
- Division of Cardiology, Bluhm Cardiovascular Institute Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Vallerie McLaughlin
- University of Michigan Hospital and Health Systems, Ann Arbor, Michigan, USA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia, USA; AdventHealth, Orlando, Florida, USA
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3
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Manzi L, Sperandeo L, Forzano I, Castiello DS, Florimonte D, Paolillo R, Santoro C, Mancusi C, Di Serafino L, Esposito G, Gargiulo G. Contemporary Evidence and Practice on Right Heart Catheterization in Patients with Acute or Chronic Heart Failure. Diagnostics (Basel) 2024; 14:136. [PMID: 38248013 PMCID: PMC10814482 DOI: 10.3390/diagnostics14020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Heart failure (HF) has a global prevalence of 1-2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% have heart failure with preserved ejection fraction (HFpEF). HF is associated with high morbidity and mortality, and HF-related hospitalizations are common, costly, and impact both quality of life and prognosis. More than 5-10% of patients deteriorate into advanced HF (AdHF) with worse outcomes, up to cardiogenic shock (CS) condition. Right heart catheterization (RHC) is essential to assess hemodynamics in the diagnosis and care of patients with HF. The aim of this article is to review the evidence on RHC in various clinical scenarios of patients with HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (L.S.); (I.F.); (D.S.C.); (D.F.); (R.P.); (C.S.); (C.M.); (L.D.S.); (G.E.)
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4
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Hiremath G, Batlivala S, Callahan R, Thatte N, Rockefeller T, Nawaytou H, Reddy SV, Hussain T, Chabiniok R, Butts R, Vettukattil J, Aregullin EO, Aldweib N, Burkhoff D, Brener MI. Clinical Applications of Pressure-Volume Assessment in Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100599. [PMID: 39130717 PMCID: PMC11307813 DOI: 10.1016/j.jscai.2023.100599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 08/13/2024]
Abstract
Ventricular pressure-volume (PV) loops offer unique insights into cardiovascular mechanics. PV loops can be instrumental in improving our understanding of various congenital heart diseases, including single ventricular physiology, heart failure, and pulmonary hypertension, as well as guiding therapeutic interventions. This review focuses on the theoretical and practical foundations for the acquisition and interpretation of PV loops in congenital heart disease and discusses their clinical applications.
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Affiliation(s)
- Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children’s Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Sarosh Batlivala
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan Callahan
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nikhil Thatte
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Toby Rockefeller
- Interventional Pediatric Cardiology, University of Missouri-Kansas City School of Medicine, Children’s Mercy, Kansas City, Missouri
| | - Hythem Nawaytou
- Department of Pediatrics, UCSF Benioff Children’s Hospital and the University of California, San Francisco, California
| | | | - Tarique Hussain
- Pediatric Cardiology, Children’s Medical Center, Dallas, Texas
| | | | - Ryan Butts
- Pediatric Cardiology, Children’s Medical Center, Dallas, Texas
| | - Joseph Vettukattil
- Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - E. Oliver Aregullin
- Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Nael Aldweib
- Division of Cardiovascular Medicine, Oregon Health Sciences University, Portland, Oregon
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Michael I. Brener
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
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5
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Sisinni A, Taramasso M, Praz F, Metra M, Agricola E, Margonato A, Fam N, Estevez-Loureiro R, Latib A, Messika-Zeitoun D, Conradi L, von Bardeleben RS, Sorajja P, Hahn RT, Caravita S, Maisano F, Adamo M, Godino C. Concomitant Transcatheter Edge-to-Edge Treatment of Secondary Tricuspid and Mitral Regurgitation: An Expert Opinion. JACC Cardiovasc Interv 2023; 16:127-139. [PMID: 36697147 DOI: 10.1016/j.jcin.2022.11.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023]
Abstract
Secondary (functional) tricuspid regurgitation (sTR) is common in patients with mitral regurgitation (MR). Because combined valvular heart disease affects long-term survival, in comparison with isolated MR or tricuspid regurgitation, it is essential to offer patients adequate treatment. Despite considerable experience, no conclusive data are yet available on the prognostic impact of concomitant tricuspid valve surgery at the time of mitral valve surgery. Emerging transcatheter treatments offer the opportunity to treat both conditions (MR and sTR) simultaneously or in a stepwise fashion. This review provides a clinical overview on available data regarding the rationale for treatment of sTR in patients with relevant MR undergoing mitral transcatheter edge-to-edge repair, focusing on clinical and anatomical selection criteria.
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Affiliation(s)
- Antonio Sisinni
- Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy; Università degli studi di Milano, Milan, Italy. https://twitter.com/antosis_93
| | | | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marco Metra
- Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic- Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Alberto Margonato
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Rebecca T Hahn
- NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
| | - Sergio Caravita
- Dyspnea and Pulmonary Hypertension Center, Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology Unit, Cardiothoracic Department, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Cosmo Godino
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
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Ghio S, Acquaro M, Agostoni P, Ambrosio G, Carluccio E, Castiglione V, Colombo D, D’Alto M, Delle Grottaglie S, Dini FL, Emdin M, Fortunato M, Guaricci AI, Jacoangeli F, Marra AM, Paolillo S, Papa S, Scajola LV, Correale M, Palazzuoli A. Right heart failure in left heart disease: imaging, functional, and biochemical aspects of right ventricular dysfunction. Heart Fail Rev 2022:10.1007/s10741-022-10276-0. [DOI: 10.1007/s10741-022-10276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/17/2022]
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