Elucidating the Clinical Implications and Pathophysiology of Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction: A Call to Action: A Scientific Statement From the American Heart Association

• Published in: Circulation (New York, N.Y.) N.Y.), 2022-07, Vol.146 (7), p.e73-e88
• Main Authors: Brittain, Evan L, Thenappan, Thenappan, Huston, Jessica H, Agrawal, Vineet, Lai, Yen-Chun, Dixon, Debra, Ryan, John J, Lewis, Eldrin F, Redfield, Margaret M, Shah, Sanjiv J, Maron, Bradley A
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIR.0000000000001079

This statement focuses on the need to better understand the epidemiology, pathophysiology, and treatment of pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction. This clinical phenotype is important because it is common, strongly associated with adverse outcomes, and lacks evidence-based therapies. Our goal is to clarify key knowledge gaps around PH due to HF with preserved ejection fraction and to suggest specific, actionable scientific directions for addressing such gaps. Areas in need of additional investigation include refined disease definitions and interpretation of hemodynamics as well as greater insights on non-cardiac contributors to PH risk, optimized animal models, and further molecular studies in patients with combined pre- and post-capillary PH. We highlight translational approaches that may provide important biologic insight into pathophysiology and reveal new therapeutic targets. Finally, we discuss the current and future landscape of potential therapies for patients with heart failure with preserved ejection fraction and pulmonary vascular dysfunction including considerations of precision medicine, novel trial design, and device-based therapies among other considerations. This statement provides a synthesis of important knowledge gaps culminating in a collection of specific research priorities that we argue warrant investment from the scientific community.