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Postcapillary pulmonary hypertension: diagnosis and treatment prospects

Authors: Shmalts A.A.1 2, Chernogrivov I.E.1

Company: 1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
2 Russian State Medical Postgraduate Academy, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2025-19-2-131-145

For citation: Shmalts A.A., Chernogrivov I.E. Postcapillary pulmonary hypertension: diagnosis and treatment prospects. Creative Cardiology. 2025; 19 (2): 131–145 (in Russ.). DOI: 10.24022/1997-3187-2025-19-2-131-145

Received / Accepted:  26.02.2025 / 03.03.2025

Keywords: pulmonary hypertension left heart diseases pulmonary hypertension due to left heart disease isolated postcapillary pulmonary hypertension combined post- and precapillary pulmonary hypertension treatment prospects



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Abstract

Pulmonary hypertension (PH) associated with left heart disease is the most common form of PH. At the onset of the disease, isolated postcapillary PH occurs, a consequence of passive pressure transmission from the pulmonary veins. With prolonged existence of isolated postcapillary PH, remodeling of the pulmonary vessels (venules and then arterioles) occurs with an increase in pulmonary vascular resistance (PVR) and the formation of combined post- and precapillary PH, when, despite severe left heart disease, right ventricular failure (the so-called right ventricular phenotype) can play a significant role in the clinical picture.

The review shows that the value of PVR value is an integral indicator of PH due to left heart disease, which determines the reversibility of PH and the tactics of management; Treatment of postcapillary PH is based on optimization of therapy of underlying diseases, however, progressive right ventricular dysfunction is an independent factor in worsening prognosis, making maintenance of right heart function an important task; There is currently some data on the efficacy of sildenafil in patients with combined postcapillary PH in heart failure with preserved ejection fraction; The use of phosphodiesterase-5 inhibitors in isolated postcapillary PH, as well as other pulmonary vasodilators, is accompanied by clinical deterioration; Timely replacement or plastic surgery of heart valves in most cases allows to eliminate postcapillary PH, while residual PH worsens surgical results; Long-term survival after valve replacement is worse in the case of initial combined postcapillary PH (compared to isolated); Regression of PH after surgical treatment depends on the reversibility of pulmonary vascular disease and the completeness of reverse remodeling of the left heart; Patients with left heart disease and pulmonary hypertension with signs of a pronounced precapillary component and/or markers of right ventricular dysfunction require specialized examination.


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About Authors

  • Anton A. Shmalts, Dr. Med. Sci., Leading Researcher, Associate Professor; ORCID
  • Igor E. Chernogrivov, Dr. Med. Sci., Head of Cardiac Surgery Department № 7; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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