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Management of heart failure with pulmonary hypertension

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Abstract

Heart failure (HF) and pulmonary hypertension (PH) coexist frequently and contribute to each other. Because PH often is an insidious disease, the cornerstone of management is the early identification and treatment of its underlying causes, such as left-sided heart disease, left to right shunts, and pulmonary disorders. A practical clinical classification has been proposed by the Third World Symposium on Pulmonary Arterial Hypertension for the purpose of diagnosis and treatment of PH. Thromboembolic pulmonary hypertension should always be considered. Recent studies using vasodilators such as prostacyclins and endothelin antagonists give new hope in the otherwise poor prognosis of idiopathic pulmonary arterial hypertension and its related conditions. Despite optimum medical management, transplantation (lung/heart-lung) remains the choice in severely symptomatic patients.

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References and Recommended Reading

  1. Colucci WS, Braunwald E: Pathophysiology of heart failure. In Heart Disease: A Textbook of Cardiovascular Medicine, edn 5. Edited by Braunwald E. Philadelphia: WB Saunders; 1997:394.

    Google Scholar 

  2. Macnee W: Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease. Part one. Am J Respir Crit Care Med 1994, 150:833–852.

    PubMed  CAS  Google Scholar 

  3. Fishman AP: Induction to the national registry on primary pulmonary hypertension. In The Pulmonary Circulation: Normal and Abnormal. Mechanisms, Management and the National Registry. Edited by Fishman AP. Philadelphia: University of Pennsylvania; 1990:343–352.

    Google Scholar 

  4. Rich S, Rubin LJ, Abenhail L, et al.: Executive summary from the World Symposium on Primary Pulmonary Hypertension The World Health Organization. Evian, France; September 6–10, 1998. http://www.who.int/ncd/cvd/pph.html

    Google Scholar 

  5. Simonneau G, Galie N, Rubin J, et al.: Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004, 43(12 Suppl S):5S-12S. An excellent description of the evolution of clinical classification of PH and its relevance on day to day management of the problem.

    Article  PubMed  Google Scholar 

  6. Wagenvoort CA: Pathology of Pulmonary Hypertension. New York: John Wiley; 1977:217–231.

    Google Scholar 

  7. Saad EB, Marrouche NF, Saad CP, et al.: Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 2003, 108:3102–3107.

    Article  PubMed  Google Scholar 

  8. Schwartzman D, Kanzaki H, Bazaz R, et al.: Impact of catheter ablation on pulmonary vein morphology and mechanical function. J Cardiovasc Electrophysiol 2004, 15:161–167.

    Article  PubMed  Google Scholar 

  9. Yataco J, Stoller JK: Pulmonary venous thrombosis and infarction complicating pulmonary venous stenosis following radiofrequency ablation. Respir Care 2004, 49:1525–1527.

    PubMed  Google Scholar 

  10. Leatham A: The second heart sound. Key to auscultation of the heart. Acta Cardiol 1964, 19:395–416.

    PubMed  CAS  Google Scholar 

  11. Wood P: The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J 1958, 46:755–762.

    Article  Google Scholar 

  12. Somerville J: Paul Wood Lecture. The master’s legacy: the first Paul Wood Lecture. Heart 1998, 80:612–619. A very interesting lecture about the master clinician, describing his classic work on Eisenmenger syndrome, among many others.

    PubMed  CAS  Google Scholar 

  13. O’Rourke RA, Shaver JA, Salerni R, et al.: The history, physical examination and cardiac auscultation. In Hurst’s the Heart Arteries and Veins, edn 9. Edited by Alexander RW, Schlant RC, Fuster V. New York: McGraw-Hill; 1998:292.

    Google Scholar 

  14. Ahearn GS, Tapson VF, Rebeiz A, et al.: Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease. Chest 2002, 122:524–527.

    Article  PubMed  Google Scholar 

  15. Ferrari E, Imbert A, Chevalier P, et al.: The ECG in pulmonary embolism. Predictive value of negative T waves in precordial leads-80 case reports. Chest 1997, 111:537–543.

    PubMed  CAS  Google Scholar 

  16. Rodger M, Makropulos D, Turek M, et al.: Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000, 86:807–809, A10.

    Article  PubMed  CAS  Google Scholar 

  17. Stein PD, Saltzman HA, Weg JG: Clinical characteristics of patients with acute pulmonary embolism. Am J Cardiol 1991, 68:1723–1724.

    Article  PubMed  CAS  Google Scholar 

  18. Milne EN, Pistolesi M, Miniati M, et al.: The radiologic distinction of cardiogenic and noncardiogenic edema. AJR Am J Roentgenol 1985, 144:879–894.

    PubMed  CAS  Google Scholar 

  19. Steiner RM, Levin DC: Radiology of the heart and great vessels. In Heart Disease: A Textbook of Cardiovascular Medicine, edn 5. Edited by Braunwald E. Philadelphia: WB Saunders; 1997:218–219.

    Google Scholar 

  20. Thomas JD, Weyman AE: Echocardiographic Doppler evaluation of left ventricular diastolic function. Physics and physiology. Circulation 1991, 84:977–990.

    PubMed  CAS  Google Scholar 

  21. Isobe M, Yazaki Y, Takaku F, et al.: Prediction of pulmonary arterial pressure in adults by pulsed Doppler echocardiography. Am J Cardiol 1986, 57:316–321.

    Article  PubMed  CAS  Google Scholar 

  22. Van Hare GF, Silverman NH: Contrast two-dimensional echocardiography in congenital heart disease: techniques, indications and clinical utility. J Am Coll Cardiol 1989, 13:673–686.

    Article  PubMed  Google Scholar 

  23. Barst RJ, McGoon M, Torbicki A, et al.: Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004, 43(12 Suppl S):40S-47S.

    Article  PubMed  Google Scholar 

  24. Bady E, Achkar A, Pascal S, et al.: Pulmonary arterial hypertension in patients with sleep apnoea syndrome. Thorax 2000, 55:934–939.

    Article  PubMed  CAS  Google Scholar 

  25. Moser K, Bloor C: Pulmonary vascular lesions occurring in patients with chronic major vessel thromboembolic pulmonary hypertension. Chest 1993, 103:685–692.

    PubMed  CAS  Google Scholar 

  26. Yusuf S, Pfeffer MA, Swedberg K, et al.: Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003, 362:777–781.

    Article  PubMed  CAS  Google Scholar 

  27. Hodgkin JE: Prognosis in chronic obstructive pulmonary disease. Clin Chest Med 1990, 11:555–569.

    PubMed  CAS  Google Scholar 

  28. Barst RJ, Rubin LJ, Long WA, et al.: A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. The Primary Pulmonary Hypertension Study Group. N Engl J Med 1996, 334:296–302.

    Article  PubMed  CAS  Google Scholar 

  29. McLaughlin VV, Shillington A, Rich S: Survival in primary pulmonary hypertension: the impact of epoprostenol therapy. Circulation 2002, 106:1477–1482.

    Article  PubMed  CAS  Google Scholar 

  30. Nagaya N, Uematsu M, Satoh T, et al.: Serum uric acid levels correlate with the severity and the mortality of primary pulmonary hypertension. Am J Respir Crit Care Med 1999, 160:487–492.

    PubMed  CAS  Google Scholar 

  31. Nagaya N, Nishikimi T, Uematsu M, et al.: Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 2000, 102:865–870.

    PubMed  CAS  Google Scholar 

  32. Robbins IM, Christman BW, Newman JH, et al.: A survey of diagnostic practices and the use of epoprostenol in patients with primary pulmonary hypertension. Chest 1998, 114:1269–1275.

    PubMed  CAS  Google Scholar 

  33. Alchanatis, Tourkohoriti G, Kakouros S, et al.: Daytime pulmonary hypertension in patients with obstructive sleep apnea: the effect of continuous positive airway pressure on pulmonary hemodynamics. Respiration 2001, 68:566–572.

    Article  PubMed  CAS  Google Scholar 

  34. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal oxygen therapy trial groupAnn Intern Med 1980, 93:391–398.

  35. Redfield M, Jacobsen SJ, Burnett JC, et al.: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003, 289:194–202.

    Article  PubMed  Google Scholar 

  36. Rich S, Braunwald E, Grossman W: Pulmonary hypertension. In Heart Disease: A Textbook of Cardiovascular Medicine, edn 5. Edited by Braunwald E. Philadelphia: WB Saunders; 1997:797.

    Google Scholar 

  37. The effect of digoxin on mortality and morbidity in patients with heart failure. The Digitalis Investigation Group. N Engl J Med 1997, 336:525–533.

  38. Shaffer EM, Rocchini AP, Spicer RL, et al.: Effects of verapamil on left ventricular diastolic filling in children with hypertrophic cardiomyopathy. Am J Cardiol 1988, 61:413–417.

    Article  PubMed  CAS  Google Scholar 

  39. Yamakado T, Okano H, Higashiyama S, et al.: Effects of nifedipine on left ventricular diastolic function in patients with asymptomatic or minimally symptomatic hypertrophic cardiomyopathy. Circulation 1990, 81:593–601.

    PubMed  CAS  Google Scholar 

  40. Young JB, Dunlap ME, Pfeffer MA, et al.: Mortality and morbidity reduction with candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials. Circulation 2004, 110:2618–2626.

    Article  PubMed  CAS  Google Scholar 

  41. Humbert M, Morrell NW, Archer SL, et al.: Cellular and molecular pathobiology of pulmonary arterial hypertension. J Am Coll Cardiol 2004, 43(12 Suppl S):13S-24S.

    Article  PubMed  CAS  Google Scholar 

  42. Humbert M, Sitbon O, Simonneau G: Treatment of pulmonary arterial hypertension. N Engl J Med 2004, 351:1425–1436. A concise, yet complete review of the pharmacotherapy of PH.

    Article  PubMed  CAS  Google Scholar 

  43. Rich S, Kauffman E, Levy PS: The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N Engl J Med 1992, 327:76–81.

    Article  PubMed  CAS  Google Scholar 

  44. Sitbon O, Humbert M, Jagot JL, et al.: Inhaled nitric oxide as a screening agent for safely identifying responders to oral calcium-channel blockers in primary pulmonary hypertension. Eur Respir J 1998, 12:265–270.

    Article  PubMed  CAS  Google Scholar 

  45. Badesch DB, Tapson VF, McGoon MD, et al.: Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease. A randomized, controlled trial. Ann Intern Med 2000, 132:425–434.

    PubMed  CAS  Google Scholar 

  46. Simonneau G, Barst RJ, Galie N, et al.: Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a doubleblind, randomized, placebo-controlled trial. Am J Respir Crit Care Med 2002, 165:800–804.

    PubMed  Google Scholar 

  47. Vachiery JL, Hill N, Zwicke D, et al.: Transitioning from i.v. epoprostenol to subcutaneous treprostinil in pulmonary arterial hypertension. Chest 2002, 121:1561–1565.

    Article  PubMed  CAS  Google Scholar 

  48. Hoeper MM, Schwarze M, Ehlerding S, et al.: Long-term treatment of primary pulmonary hypertension with aerosolized iloprost, a prostacyclin analogue. N Engl J Med 2000, 342:1866–1870.

    Article  PubMed  CAS  Google Scholar 

  49. Barst RJ, McGoon M, McLaughlin V, et al.: Beraprost therapy for pulmonary arterial hypertension. J Am Coll Cardiol 2003, 41:2119–2125.

    Article  PubMed  CAS  Google Scholar 

  50. Channik RN, Simonneau G, Sitbon O, et al.: Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study. Lancet 2001, 358:1119–1123.

    Article  Google Scholar 

  51. Sitbon O, Badesch DB, Channik RN, et al.: Effects of the dual endothelin receptor antagonist bosentan in patients with pulmonary arterial hypertension: a 1-year follow-up study. Chest 2003, 124:247–254.

    Article  PubMed  CAS  Google Scholar 

  52. Sastry BK, Narasimhan C, Reddy NK, et al.: Clinical efficacy of sildenafil in primary pulmonary hypertension: a randomized, placebo-controlled, bddouble-blind, crossover study. J Am Coll Cardiol 2004, 43:1149–1153. A small but well-designed study showing the efficacy of a simple, orally administered medicine.

    Article  PubMed  CAS  Google Scholar 

  53. Humbert M, Barst RJ, Robbins IM, et al.: Combination of bosentan with epoprostenol in pulmonary arterial hypertension: BREATHE-2. Eur Respir J 2004, 24:353–359.

    Article  PubMed  CAS  Google Scholar 

  54. Galie N, Seeger W, Naeije R, et al.: Comparative analysis of clinical trials and evidence-based treatment algorithm in pulmonary arterial hypertension. J Am Coll Cardiol 2004, 43(12 Suppl S):81S-88S.

    Article  PubMed  Google Scholar 

  55. Archibald CJ, Auger WR, Fedullo PF, et al.: Long-term outcome after pulmonary thromboendarterectomy. Am J Respir Crit Care Med 1999, 160:523–528.

    PubMed  CAS  Google Scholar 

  56. Sandoval J, Gasper J, Pulido T, et al.: Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension. A therapeutic alternative for patients nonresponsive to vasodilator treatment. J Am Coll Cardiol 1998, 32:297–304.

    Article  PubMed  CAS  Google Scholar 

  57. Pielsticker EJ, Martinez FJ, Rubenfire M: Lung and heart-lung transplant practice patterns in pulmonary hypertension centers. J Heart Lung Transplant 2001, 20:1297–1304.

    Article  PubMed  CAS  Google Scholar 

  58. Deng Z, Morse JH, Slager SL, et al.: Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-II gene. Am J Hum Genet 2000, 67:737–744.

    Article  PubMed  CAS  Google Scholar 

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Osman, M.N., Dunlap, M.E. Management of heart failure with pulmonary hypertension. Curr Cardiol Rep 7, 196–203 (2005). https://doi.org/10.1007/s11886-005-0077-4

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