Why the study?
Significant advances occurred since the 5th World Symposium on Pulmonary Hypertension in 2013, highlighting challenges, diagnostic complexities in heart failure with preserved ejection fraction, and gaps in evidence.
Proposes a new haemodynamic definition and a three-step pragmatic approach for the differential diagnosis of pulmonary hypertension due to left heart disease.
Discourages PAH-approved therapies in PH due to LHD; extends guidelines with new haemodynamic definition and pragmatic diagnostic approach.
Pulmonary hypertension (PH) is frequent in left heart disease (LHD), as a consequence of the underlying condition. Significant advances have occurred over the past 5 years since the 5th World Symposium on Pulmonary Hypertension in 2013, leading to a better understanding of PH-LHD, challenges and gaps in evidence. PH in heart failure with preserved ejection fraction represents the most complex situation, as it may be misdiagnosed with group 1 PH. Based on the latest evidence, we propose a new haemodynamic definition for PH due to LHD and a three-step pragmatic approach to differential diagnosis. This includes the identification of a specific "left heart" phenotype and a non-invasive probability of PH-LHD. Invasive confirmation of PH-LHD is based on the accurate measurement of pulmonary arterial wedge pressure and, in patients with high probability, provocative testing to clarify the diagnosis. Finally, recent clinical trials did not demonstrate a benefit in treating PH due to LHD with pulmonary arterial hypertension-approved therapies.
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Vachiéry et al. (2018) studied this question.
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