Volume 10: Issue 1

Pulmonary hypertension (PH) associated with left heart disease is the single most common form of PH we encounter in clinical practice today. Divided into 3 categories – systolic dysfunction, diastolic dysfunction, valvular disease – the presence of PH is well recognized to portend worse outcome across the spectrum of cardiac disorders. PH associated with diastolic dysfunction presents unique challenges for clinicians, as at first glance it shares many similar features with pulmonary arterial hypertension (PAH). Furthermore, the incidence of PH with diastolic dysfunction is in sharp rise, in parallel with the aging population and increase in incidence of obesity. It

Summaries and commentaries from the section editors and invited reviewers present a clinical context for practitioners' application of the latest published research relevant to care of patients with pulmonary hypertension. In this issue, newly-appointed section editor Ioana Preston, MD, comments on a recent publication related to use of LVADs as a bridge to transplant.

The Ask the Expert column highlights challenges faced in caring for patients with pulmonary arterial hypertension (PAH). In this issue, Richard Krasuski, MD, comments on the role of acute vasoreactivity testing (AVT) in the heart failure population.

Increased pulmonary hypertension (PH) awareness in the general public and among health providers has led to an increase in referral of patients who are found to have elevated estimates of pulmonary artery systolic pressure (PASP) on a transthoracic echocardiogram (TTE), without other strong features suggestive of precapillary PH (pulmonary arterial hypertension; PAH). Some of these patients undergo TTE as part of their workup for unexplained dyspnea that appears out of proportion to their other comorbidities. Many of these patients are older individuals with underlying conditions such as systemic hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and obstructive sleep apnea (OSA). While some of them may have PAH, accumulated experience in the PH community suggests that many of these patients will be ultimately found to have elevated left ventricular (LV) filling pressures and impaired LV relaxation as the cause of their dyspnea and elevation of pulmonary pressures on TTE.1 2 These findings are consistent with a form of Group 2 PH termed LV diastolic dysfunction, more recently termed heart failure with preserved left ventricular systolic function (HFpEF) (Table 1).2 Other forms of Group 2 PH, defined as “pulmonary hypertension owing to left-sided heart disease,” include LV systolic dysfunction or left-sided valvular disease.2 For the purpose of this article, the term pulmonary venous hypertension (PVH) will be used to refer to Group 2 PH, HFpEF. Being able to accurately discriminate PAH (precapillary; Group 1 PH) from PVH (postcapillary; Group 2 PH) is critical to determine and apply the appropriate treatment course. This is a difficult, yet frequently encountered clinical dilemma, which can fall into a “gray zone” with respect to clinical classification. We will provide important clinical features that should heighten the clinician's awareness and suspicion of this rapidly growing phenomenon. These features are critical when trying to differentiate PAH (Group 1 PH) from PVH (Group 2 PH).

Tackling the Gray Zone

Group 2 PH: Striving To Get A Handle On This Epidemic

Reviews of the Latest Published Research

Is There a Role for Acute Vasoreactivity Testing Outside of Patients With Pulmonary Arterial Hypertension?

Pulmonary Venous Hypertension: A Pulmonologist's Perspective

Echocardiographic Assessment of Left Ventricular Diastolic Dysfunction: Differentiating a Pulmonary Vascular From a Pulmonary Venous Origin of Pulmonary Hypertension

The Nuts and Bolts of Interpreting Hemodynamics in Pulmonary Hypertension Associated With Diastolic Heart Failure

Pulmonary Hypertension: A Common Complication of Left Heart Disease

PH and Left Heart Disease: Defining the Clinical Dilemma

Fluid Volume Management in Patients With WHO Group 2 Pulmonary Hypertension

Clinical Trials Update

Conference Abstracts

Guest Editor’s Memo

A Roundtable Discussion Addressing Patient-Centered Care and Quality of Life in Patients With Pulmonary Arterial Hypertension

Editor’s Memo

Pulmonary Hypertension Associated With Parenchymal Lung Disease