Pulmonary Hypertension in Advanced Heart Failure: Assessment and Management of the Failing RV and LV. [Review]

Rao SD; Menachem JN; Birati EY; Mazurek JA.

Current Heart Failure Reports. 16(5):119-129, 2019 10.

PURPOSE OF REVIEW: In patients with heart failure with reduced ejection
fraction, the presence of pulmonary hypertension (PH-LHD) has a
significant impact on their prognosis. The purpose of this review is to
explain the methods of diagnosing PH-LHD and then discuss the available
therapeutic options.
RECENT FINDINGS: We begin by examining the methods of assessment of
PH-LHD-echocardiography, cardiopulmonary exercise testing, and right heart
catheterization-with a particular focus on the importance of accurate
measurement to ensure the proper determination of PH-LHD. We then focus
primarily on management of PH-LHD, with an examination of trials of
therapeutic options, use of mechanical circulatory support, and
transplantation. This review highlights the complexities in diagnosis and
management of PH-LHD. We outline a number of useful ways to maximize the
yield of diagnostic testing, as well as give suggestions on the use of
medical therapies, the role of both temporary mechanical support and left
ventricular assist device, and finally the ways to best bridge these
patients to transplantation.