Management of combined pre- and post-capillary pulmonary hypertension in advanced heart failure with reduced ejection fraction

Respir Med. 2017 Oct:131:94-100. doi: 10.1016/j.rmed.2017.08.006. Epub 2017 Aug 9.

Abstract

Management of pulmonary hypertension (PH) has remained an unmet need in advanced left heart failure with reduced ejection fraction. In fact, patients are frequently denied heart transplant due to untreated pulmonary hypertension. The availability of mechanically circulatory devices and PH therapies has provided a ray of hope. PH specific therapies are currently not FDA approved for patients with left heart failure with reduced ejection fraction. However, clinicians have used these medications in anecdotal manner. With this review, we want to highlight the expanding use of PH specific therapy and mechanical circulatory devices in the management of PH in the setting of advanced heart failure with reduced ejection fraction.

Keywords: Advanced heart failure; Left ventricular assist device; Mechanical circulatory devices; Precapillary pulmonary hypertension; Pulmonary hypertension.

Publication types

  • Review

MeSH terms

  • Capillaries / physiopathology
  • Disease Management
  • Endothelin Receptor Antagonists / therapeutic use*
  • Enzyme Activators / therapeutic use*
  • Heart Failure / complications
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart-Assist Devices
  • Humans
  • Hypertension, Pulmonary / etiology
  • Hypertension, Pulmonary / physiopathology
  • Hypertension, Pulmonary / therapy*
  • Phosphodiesterase 5 Inhibitors / therapeutic use*
  • Prostaglandins I / analysis*
  • Severity of Illness Index
  • Soluble Guanylyl Cyclase
  • Stroke Volume*
  • Ventricular Dysfunction, Left / complications
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Dysfunction, Left / therapy*

Substances

  • Endothelin Receptor Antagonists
  • Enzyme Activators
  • Phosphodiesterase 5 Inhibitors
  • Prostaglandins I
  • Soluble Guanylyl Cyclase