Current Treatment Strategies in Pulmonary Hypertension Associated with Left Heart Disease

Pulmonary hypertension (PH) is a common complication of left heart disease (LHD) and is associated with impaired functional capacity and decreased survival. Recent guidelines have proposed a new classification system for PH-LHD that is based on the diastolic pulmonary gradient. Despite a sound physiologic basis, subsequent studies have not found a significant correlation between the diastolic pulmonary gradient and meaningful outcomes. Treatment of PH-LHD focuses on optimizing the left heart disease. The use of medications for the treatment of combined post- and pre-capillary PH in left heart disease is controversial. While several small studies have shown hemodynamic or symptomatic improvement, none have been demonstrated to clearly improve long-term outcomes. Large, event-driven trials of PH-LHD are needed to guide the optimal management of this population.