Pulmonary Hypertension in Aortic Valve Stenosis
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abstract
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In patients with severe aortic stenosis (AS), pulmonary hypertension
(PH) typically is indicative of a decompensated disease state with
exhausted compensatory mechanisms of the left ventricle, meaning a
heart failure state resulting from AS-related "cardiac
injury". In the present review article, we discuss new insights
into the pathophysiology of AS-induced PH, the prognostic impact,
and potential options to prevent and treat PH in this setting. We
emphasize recent data from studies focused on invasive hemodynamics
in patients with severe AS that are being evaluated for aortic valve
replacement, particularly the key relevance of combined pre- and
post-capillary PH. This latter represents an advanced form of
cardiac injury that is often associated with right ventricular
dysfunction and poor prognosis. Given this context, we highlight the
relevance of performing right heart catheterization in combination
with non-invasive imaging for the comprehensive assessment of AS
patients that are being evaluated for aortic valve replacement. Such
comprehensive assessment plays a key role not only to precisely
define the extent of AS-related cardiac injury but also to
distinguish those PH forms that are unrelated to AS.
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citation
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Maeder M T, Weber L, Rickli H. Pulmonary Hypertension in Aortic
Valve Stenosis. Trends Cardiovasc Med 2020;.
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type
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journal paper/review (English)
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date of publishing
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17-12-2020
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journal title
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Trends Cardiovasc Med
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ISSN electronic
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1873-2615
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PubMed
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33346089
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DOI
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10.1016/j.tcm.2020.12.005
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