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Pulmonary hypertension in left heart disease

Marco Guazzi, Nazzareno Galiè
European Respiratory Review 2012 21: 338-346; DOI: 10.1183/09059180.00004612
Marco Guazzi
*Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, Milan, and #Institute of Cardiology, University of Bologna, Bologna, Italy.
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  • For correspondence: marco.guazzi@unimi.it
Nazzareno Galiè
*Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, Milan, and #Institute of Cardiology, University of Bologna, Bologna, Italy.
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  • For correspondence: nazzareno.galie@unibo.it
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    Figure 1.

    a) Overall survival by systolic pulmonary artery pressure (Ppa,sys) tertiles in 1,049 heart failure patients (p<0.001). b) Survival from cardiovascular death by Ppa,sys tertiles in 975 heart failure patients (p<0.001). Reproduced from [9] with permission from the publisher.

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    Figure 2.

    Diagnostic approach to distinguishing between pulmonary arterial hypertension (PAH) and pulmonary hypertension (PH) caused by diastolic left heart disease. RHC: right heart catheterisation; Ppcw: pulmonary capillary wedge pressure; PVR: pulmonary vascular resistance; RCT: randomised controlled trial; WU: Wood units. Reproduced from [50] with permission from the publisher.

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    Figure 3.

    Comparison between digitised pulmonary capillary wedge pressure (Ppcw,digital) and end-expiration Ppcw, and their relationship to directly measured left ventricular end-diastolic pressure (LVEDP). Box plots show the median values and interquartile range. Error bars represent values within two standard deviations of the mean. Dots represent outliers. Ppcw,digital was significantly lower (p<0.05) than end-expiration Ppcw and LVEDP. Reproduced from [55] with permission from the publisher.

Tables

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  • Table 1. Classification of pulmonary hypertension (PH) owing to left heart diseases
    Heart failure with reduced left ventricle ejection fraction (ejection fraction ≤50%#; systolic dysfunction¶)
        Ischaemic cardiomyopathy
        Dilated cardiomyopathy
    Heart failure with preserved left ventricle ejection fraction (ejection fraction >50%#; diastolic dysfunction¶)
        Hypertensive heart disease
        Coronary heart disease
        Diabetic cardiomyopathy
        Hypertrophic cardiomyopathy
        Restrictive cardiomyopathy
        Constrictive pericarditis
    Valvular diseases
        Aortic valve stenosis
        Aortic valve regurgitation
        Mitral valve stenosis
        Mitral valve regurgitation
        Persistent/residual PH after effective valvular defect correction
    Other causes
        Cor triatriatum
        Myxoma or left atrial thrombus
    • #: the cut-off value for preserved versus reduced ejection fraction varies between studies; ¶: definition from Simonneau et al. [2]. Modified from [4].

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Pulmonary hypertension in left heart disease
Marco Guazzi, Nazzareno Galiè
European Respiratory Review Dec 2012, 21 (126) 338-346; DOI: 10.1183/09059180.00004612

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Pulmonary hypertension in left heart disease
Marco Guazzi, Nazzareno Galiè
European Respiratory Review Dec 2012, 21 (126) 338-346; DOI: 10.1183/09059180.00004612
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  • Article
    • Abstract
    • PATHOPHYSIOLOGY OF PH-LHD
    • EPIDEMIOLOGY AND NATURAL HISTORY OF PH-LHD
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    • CONCLUSION
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