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A roadmap for therapeutic discovery in pulmonary hypertension associated with left heart failure. A scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Pulmonary Circulation & Right Ventricular Function

Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatme...

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Main Authors: Ameri, Pietro (Author) , Mercurio, Valentina (Author) , Pollesello, Piero (Author) , Anker, Markus S. (Author) , Backs, Johannes (Author) , Bayes-Genis, Antoni (Author) , Borlaug, Barry A. (Author) , Burkhoff, Daniel (Author) , Caravita, Sergio (Author) , Chan, Stephen Y. (Author) , de Man, Frances (Author) , Giannakoulas, George (Author) , González, Aránzazu (Author) , Guazzi, Marco (Author) , Hassoun, Paul M. (Author) , Hemnes, Anna R. (Author) , Maack, Cristoph (Author) , Madden, Brendan (Author) , Melenovsky, Vojtech (Author) , Müller, Oliver J. (Author) , Papp, Zoltan (Author) , Pullamsetti, Soni Savai (Author) , Rainer, Peter P. (Author) , Redfield, Margaret M. (Author) , Rich, Stuart (Author) , Schiattarella, Gabriele G. (Author) , Skaara, Hall (Author) , Stellos, Konstantinos (Author) , Tedford, Ryan J. (Author) , Thum, Thomas (Author) , Vachiery, Jean Luc (Author) , van der Meer, Peter (Author) , Van Linthout, Sophie (Author) , Pruszczyk, Piotr (Author) , Seferovic, Petar (Author) , Coats, Andrew J.S. (Author) , Metra, Marco (Author) , Rosano, Giuseppe (Author) , Rosenkranz, Stephan (Author) , Tocchetti, Carlo Gabriele (Author)
Format: Article (Journal)
Language:English
Published: April 2024
In: European journal of heart failure
Year: 2024, Volume: 26, Issue: 4, Pages: 707-729
ISSN:1879-0844
DOI:10.1002/ejhf.3236
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ejhf.3236
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.3236
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Author Notes:Pietro Ameri, Valentina Mercurio, Piero Pollesello, Markus S. Anker, Johannes Backs, Antoni Bayes-Genis, Barry A. Borlaug, Daniel Burkhoff, Sergio Caravita, Stephen Y. Chan, Frances de Man, George Giannakoulas, Aránzazu González, Marco Guazzi, Paul M. Hassoun, Anna R. Hemnes, Cristoph Maack, Brendan Madden, Vojtech Melenovsky, Oliver J. Müller, Zoltan Papp, Soni Savai Pullamsetti, Peter P. Rainer, Margaret M. Redfield, Stuart Rich, Gabriele G. Schiattarella, Hall Skaara, Kostantinos Stellos, Ryan J. Tedford, Thomas Thum, Jean Luc Vachiery, Peter van der Meer, Sophie Van Linthout, Piotr Pruszczyk, Petar Seferovic, Andrew J.S. Coats, Marco Metra, Giuseppe Rosano, Stephan Rosenkranz, and Carlo Gabriele Tocchetti

MARC

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520 |a Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatments for PH-LHF, despite the high number of drugs tested so far. This scientific document addresses the main knowledge gaps in PH-LHF with emphasis on pathophysiology and clinical trials. Key identified issues include better understanding of the role of pulmonary venous versus arteriolar remodelling, multidimensional phenotyping to recognize patient subgroups positioned to respond to different therapies, and conduct of rigorous pre-clinical studies combining small and large animal models. Advancements in these areas are expected to better inform the design of clinical trials and extend treatment options beyond those effective in pulmonary arterial hypertension. Enrichment strategies, endpoint assessments, and thorough haemodynamic studies, both at rest and during exercise, are proposed to play primary roles to optimize early-stage development of candidate therapies for PH-LHF. 
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