Background
Pulmonary hypertension (PH) is divided into five distinct groups, which are categorized according to similar pathophysiologic changes, clinical presentation, and available therapies. Pulmonary hypertension due to left-sided heart disease (PH-LHD), classified by the World Health Organization (WHO) into group 2 pulmonary hypertension, is the most common cause of pulmonary hypertension and is associated with impaired exercise capacity and reduced survival.
It is defined by a mean pulmonary arterial pressure (mPAP) greater than 20 mm Hg and pulmonary capillary wedge pressure (PCWP) greater than 15 mm Hg.
PH-LHD is further categorized by the underlying etiology, including due to systolic dysfunction, diastolic dysfunction, valvular defects, congenital or acquired left-sided heart inflow/outflow tract obstruction, and congenital cardiomyopathies. The pathophysiology is complex and features both a passive and an active mechanism of changes to the pulmonary vasculature.