Search

Patients with left heart disease (LHD) often display pulmonary hypertension (PH), which impacts morbidity and mortality. The pathophysiology of PH is complex and entails pulmonary congestion due to elevated left-sided filling pressures, pulmonary vasoconstriction as well as vascular remodeling. The recent ESC/ERS Guidelines on pulmonary hypertension updated the hemodynamic definitions of pulmonary hypertension in general, and the subclassification of post-capillary PH. This review summarizes recent advances in the diagnostic work-up and management strategies of PH associated with LHD. Specifically, we summarize revisited hemodynamic definitions and the characteristics of isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH). Furthermore, we review the current knowledge on the pathogenesis of PH-LHD, the prognostic relevance of hemodynamic parameters, and the management strategies, differentiating between treatment of the underlying left heart disease and therapies targeting the pulmonary circulation. The article emphasises the need for precise diagnostic work-up and individualized treatment strategies in patients with PH-LHD., Competing Interests: MW: Vortragshonorare von Janssen; JA: Vortragshonorare von Janssen und MSD; CH: Honorare für Vorträge und/oder Beratertätigkeiten: Actelion, Bayer, MSD, Pfizer; SR: Honorare für Vorträge und/oder Beratertätigkeiten: Abbott, Acceleron, Actelion, Aerovate, Altavant, AOP Orphan, AstraZeneca, Bayer, Boehringer-Ingelheim, Edwards, Ferrer, Gossamer, Janssen, MSD, United Therapeutics, Vifor; Forschungsunterstützung an Institution: Actelion, AstraZeneca, Bayer, Janssen; JD, LO, TT und SB: keine Interessenkonflikte im Zusammenhang mit diesem Artikel., (Thieme. All rights reserved.)

Mitral regurgitation (MR) is one of the most common valvular defects in the eldery. In patients suffering from heart failure, secondary MR is common and associated with worse prognosis. Due to the usually very high operative risk these patients are immensely under-treated. This leads to an increased need for interventional treatment strategies. Until now there were no randomized data regarding the prognostic impact of interventional treatment of secondary MR. This article is supposed to sum up evidence derived from recent studies regarding this issue. Finally we will provide an outlook on catheter-based mitral valve prothesis., Competing Interests: Dr. Körber gibt an, dass kein Interessenkonflikt besteht.Prof. Pfister erhielt Reisekostenerstattung und Vortragshonorar von Abbott.Prof. Baldus hat educational grants und research grants von Abbott und Edwards erhalten., (© Georg Thieme Verlag KG Stuttgart · New York.)

There is growing understanding to recognize the aorta as complex system and treat aortic diseases in an integrated fashion.The indication for interventional aortic valve replacement (TAVR) comprises patients with moderate and high perioperative risk and symptomatic, high grade aortic valve stenosis. In contrast "low risk" patients receive conventional therapy. Ongoing randomised trials analyse the expansion of indication towards low risk patients for interventional approaches. A final rating is owing, but first data support the assumption that both therapeutic options may be equivalent. Moreover, the interventional therapy of low flow, low gradient aortic valve stenosis has been revalued and interventional valve-in-valve therapy has been integrated into clinical routine as invidualised decision of the heart team.Aortic diseases include several entities which require specialised diagnostic and therapeutic tools. Studies to evaluate evidence of follow up options need to be performed in future to enable for surveillance tailored to suit medical need., Competing Interests: Dr. med. Christine Quast: Research Funding: Forschungskommission Düsseldorf.PD Dr. med. Sebastian Zimmer: Honoraria: Abbot, Abiomed, Astra Zeneca, Bayer, Böhringer Ingelheim, Medtronic, Novartis; Research Funding: DFG, BONFOR.Dr. med. Matti Adam: Honoraria: Abbott, Bayer, Medtronic; Clinical Trials: Boston Scientific, Edwards, Medtronic; Research funding: DFG.Prof. Dr. med. Stephan Baldus: Honoraria: Abbott, Astra, Bayer, Berlin Chemie, Cardiovalve, Daiichi Sankyo, Medtronic, Pfizer, Servier; Clinical Trials: Abbott, Astra, Boston Scientific, Cardiovalve, Edwards, Medtronic, Novartis, Pfizer, Servier; Research funding: DFG, Abbott, Actelion, Astra Zeneca, Bayer, Edwards, Pfizer.Prof. Dr. med. Georg Nickenig: Honoraria for lectures or advisory boards: Abbott, AGA, AstraZeneca, Bayer, Berlin Cardiovalve, Chemie, Biosensus, Biotronic, BMS, Boehringer Ingelheim, Daiichi Sankyo, Edwards, Medtronic, Novartis, Pfizer, Sanofi Aventis, St. Jude; Participation in clinical trials: Abbott, AGA, AstraZeneca, Bayer, Berlin Chemie, Biosensus, Biotronic, BMS, Boehringer Ingelheim, Cardiovalve, Daiichi Sankyo, Edwards, Medtronic, Novartis, Pfizer, Sanofi Aventis, St. Jude; Research funding: DFG, BMBF, EU, Abbott, AGA, AstraZeneca, Bayer, Berlin Chemie, Biosensus, Biotronic, BMS, Boehringer Ingelheim, Daiichi Sankyo, Edwards, Medtronic, Novartis, Pfizer, Sanofi Aventis, St. Jude.Prof. Dr. med. Malte Kelm: Honoraria: Bayer, Research funding: DFG, Philipps, Med. in NRW, Mars inc., Profil, (© Georg Thieme Verlag KG Stuttgart · New York.)

An invasive measurement of the fractional flow reserve (FFR) allows the valuation of the individual risk for ischemic events in patients with coronary artery disease. Therefore, FFR has become a valuable tool to guide coronary revascularisations. The cut-off value ≤ 0.80 has been validated in many different subsets of patients. However, FFR values describe a risk continuum with an inverse correlation between FFR value and the risk of events. So FFR should always be interpreted regarding the patient's clinical context, especially in patients with a high risk for rapid disease progression. As such, patients with diabetes mellitus and deferred revascularisation based on FFR > 0.80 had worse clinical outcomes compared to patients without diabetes. In addition, FFR shows methodical deficiencies concerning the quantification of serial stenoses as well as the valuation of residual ischemia of the culprit vessel early after myocardial infarction. This article highlights both the strengths and the pitfalls in the use and interpretation of FFR., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aortic regurgitation is the consequence of a heterogenous alterations to the aortic valve and ascending aorta, respectively. Due to the widespread use of transcatheter aortic valve implantation, paravalvular leakage has gained interest as a special subtype of aortic regurgitation. The present article summarizes the current state and recent developments in the diagnostics and therapy of the different forms of aortic regurgitation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Due to the demographic change, chronic valvular heart disease becomes increasingly important - especially age-related primary diseases of the aortic and mitral valve as well as secondary diseases of the mitral and tricuspid valve caused by other age-related cardiac disorders. Medical treatment is limited to symptom relief by use of diuretics. Specific drugs or drugs with a prognostic benefit are not available. Thus, valve repair or replacement are the key options for treatment of relevant valvular heart disease. While open heart surgery was the only approach for a long time, interventional, catheter-based therapies have evolved in the last decade. This article describes up-to-date recommendations on indications for surgery for the most prevalent valvular heart diseases in adults - aortic stenosis, and aortic, mitral and tricuspid regurgitation)., (© Georg Thieme Verlag KG Stuttgart · New York.)