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

• Published in: Respiratory medicine 2017-10, Vol.131, p.94-100
• Main Authors: Sahay, Sandeep, Khirfan, Ghaleb, Tonelli, Adriano R.
• Format: Article
• Language: English
• Subjects: Advanced heart failure; Beta blockers; Capillaries - physiopathology; Clinical outcomes; Devices; Disease Management; Ejection fraction; Endothelin Receptor Antagonists - therapeutic use; Enzyme Activators - therapeutic use; Heart; Heart diseases; Heart failure; Heart Failure - complications; Heart Failure - physiopathology; Heart Failure - therapy; Heart transplantation; Heart-Assist Devices; Humans; Hypertension; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - therapy; Left ventricular assist device; Mechanical circulatory devices; Mortality; Nitric oxide; Patients; Phosphodiesterase 5 Inhibitors - therapeutic use; Precapillary pulmonary hypertension; Prostaglandins I - analysis; Pulmonary arteries; Pulmonary hypertension; Severity of Illness Index; Soluble Guanylyl Cyclase; Stroke Volume; Transplants & implants; Veins & arteries; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2017.08.006

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. •To highlight the role of PAH specific therapies in pulmonary hypertension due to left heart failure with reduced ejection fraction.•Currently there are no FDA approved therapies for these patients.•PAH specific therapies are often used off label in this group of patients.•We are reviewing the currently available evidence highlighting the role of PAH specific therapy in this setting.