Pulmonary Hypertension in Advanced Heart Failure: Assessment and Management of the Failing RV and LV

  • Sriram D. Rao
  • Jonathan N. Menachem
  • Edo Y. Birati
  • Jeremy A. MazurekEmail author
Updates in Advanced Heart Failure (E. Rame and M. St. John Sutton, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Updates in Advanced Heart Failure


Purpose of Review

In patients with heart failure with reduced ejection fraction, the presence of pulmonary hypertension (PH-LHD) has a significant impact on their prognosis. The purpose of this review is to explain the methods of diagnosing PH-LHD and then discuss the available therapeutic options.

Recent Findings

We begin by examining the methods of assessment of PH-LHD—echocardiography, cardiopulmonary exercise testing, and right heart catheterization—with a particular focus on the importance of accurate measurement to ensure the proper determination of PH-LHD. We then focus primarily on management of PH-LHD, with an examination of trials of therapeutic options, use of mechanical circulatory support, and transplantation.


This review highlights the complexities in diagnosis and management of PH-LHD. We outline a number of useful ways to maximize the yield of diagnostic testing, as well as give suggestions on the use of medical therapies, the role of both temporary mechanical support and left ventricular assist device, and finally the ways to best bridge these patients to transplantation.


Pulmonary hypertension Heart failure Post capillary Ventricular dysfunction, left Ventricular dysfunction, right 


Compliance with Ethical Standards

Conflict of Interest

Sriram D. Rao and Jonathan N. Menachem declare no conflict of interest. Dr. Birati reports personal fees from Luitpold Pharmaceuticals, Inc. Dr. Mazurek reports personal fees from Actelion Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sriram D. Rao
    • 1
  • Jonathan N. Menachem
    • 2
  • Edo Y. Birati
    • 1
  • Jeremy A. Mazurek
    • 1
    • 3
    Email author
  1. 1.Advanced Heart Failure/Transplantation Program, Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Advanced Heart Failure and Cardiac Transplant Program, Advanced Congenital Cardiac Therapies, Division of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleUSA
  3. 3.Pulmonary Hypertension Program, Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA

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