This important review highlights the data showing a strong neurohormonal maladaptive basis underlying PH-HFpEF. These data provide a compelling argument for developing novel treatments that target these abnormalities to improve outcomes.
This is the first part of an extraordinary 2-part review of the complexity of pulmonary hypertension in LV dysfunction. One particularly enlightening focus is on the difference between the reversible elevations in pulmonary pressure vs. irreversible elevations which explain why persistent pulmonary hypertension occurs in many of these patients.
Comprehensive review of the pathophysiology of HFpEF by a worldwide leader in the field. This paper explains why the term diastolic dysfunction does not adequately explain the very complex and diverse pathophysiology that underlies the abnormal compliance of the LV in HFpEF.
This review covers the role of K+ATP channels in cardiovascular disease and links cellular metabolism to clinical disease states. This suggests that the exploitation of K+ATP channel activators may prove useful as a treatment for many facets of cardiovascular disease.
Current in-depth review of the clinical features and treatment approaches. A good reference source.
This important paper reviews 2 studies investigating the effects of splanchnic nerve block (SNB) on hemodynamics in patients with decompensated and ambulatory heart failure. They found that SNB reduced the estimated stressed blood volume in both studies at rest and throughout exercise. This provides strong validation of the role of stressed blood volume in PH-HFpEF.
Very high-level review of the role of K+ channels regulating the pulmonary vasculature. They explain how K+ channel conductance plays a fundamental role in pulmonary arterial function by controlling pulmonary vascular tone, regulating the population of PASMC through controlling cell apoptosis, survival, and proliferation, and by regulating the release of endothelial vasodilator factors. Given the demonstrated role of altered K+ channels in the pathophysiology of PH, drugs targeting K+ channels, could be new promising therapeutic agents in PAH.
High level review of right ventricular adaptation in HFpEF. These experts demonstrate the critical role of the RV in this setting and illustrate that pulmonary hypertension and RV failure represents an advanced stage of HFpEF.
Comprehensive review of the relationship between the left and right ventricles in pulmonary hypertension. One cannot ignore that isolated pulmonary hypertension, even in the presence a normal left ventricle, is a biventricular disease. When there is coexisting left ventricular dysfunction the relationships become even more complex.
Sympathetic nervous system activation has been well established as a chronic maladaptive response to heart failure syndromes. This includes HFrEF, HFpEF, and right ventricular failure. Treatments that target the SNS are the basis for treating LV failure and improving survival. Traditionally they have focused on the systemic arterial circulation which plays an important role in LV failure, but an uncertain role in RV failure.