Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies—pharmacologic, device-based, and surgical therapies used for managing PH-LHD—are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.

中文翻译：

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肺动脉高压合并左心病的诊断和治疗注意事项


与左心疾病相关的肺动脉高压（PH-LHD）仍然是全球肺动脉高压的最常见原因。病因包括射血分数降低和保留的心力衰竭和左侧瓣膜性心脏病。尽管 PH-LHD 的患病率不断增加，但临床医生对血流动力学定义、诊断、治疗方式和预后仍然缺乏了解。此外，关于肺血管扩张剂治疗 PH-LHD 的有效性，临床试验得出了不同的结果。在本次专家评审中，我们概述了细致的血流动力学评估和激发测试对于诊断不确定的情况的关键作用。还概述了用于治疗 PH-LHD 的治疗策略——药物疗法、基于设备的疗法和手术疗法。简要探讨了晚期心力衰竭中的 PH-LHD，以及机械循环支持在 PH-LHD 中的作用。所有临床医生都需要深入了解 PH-LHD，以提高 PH-LHD 患者的认识和治疗结果。