Pulmonary Hypertension Clinical Trial
Official title:
Evaluation of Cardiopulmonary Metabolism and Pulmonary Vascular Remodeling in Pulmonary Hypertension Associated With Left Heart Disease
Right ventricular (RV) failure is the leading cause of death in pulmonary arterial
hypertension. (PAH) Right ventricular ejection fraction is one of the most important
predictors of prognosis in heart failure patients regardless of cause. It is estimated that
30-50% of patients with heart failure and preserved ejection fraction (HFpEF) have right
ventricular dysfunction and up to 70% of these patients will have significant pulmonary
hypertension (PH), both of which are related to much worse prognosis. Right ventricular
failure is becoming an increasingly prevalent and significant cause of morbidity in patients
with left heart disease. Despite the significance of RV function to survival, there are no
therapies available that directly or selectively improve RV function.
The overall theme of this research project is to evaluate the mechanisms that contribute to
the cause of right heart failure. This small study is designed to look at the role of heart
and lung metabolism and pulmonary hypertension as they relate to the development of right
heart failure in cardiovascular disease.(PH-LHD)
The hemodynamic definition of PH-LHD involves a mean pulmonary artery pressure (mPAP) >25mm
Hg at rest and pulmonary capillary wedge pressure (PCWP) of ≥15.The coexistence of mitral
insufficiency is also a characteristic of PH-LHD. HFpEF is a condition caused by impaired
relaxation of a stiffened myocardium as a consequence of an increased load to the left
ventricle due to elevated systemic pressures.
Pulmonary hemodynamics can be used to classify PH LHD as either passive or reactive,
irrespective of LV function. It has been suggested that diastolic pressure gradient (DPG) may
offer added prognostic value as a more accurate indicator of pulmonary vascular remodeling.
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