Right ventricular/pulmonary artery coupling in patients with heart failure with preserved ejection fraction. a clue for pulmonary hypertension

pulmonary hypertension (PH) in left heart disease is a common condition, primarily caused by backward transmission of an elevated left atrial pressure (this hemodynamic picture is defined as isolated postcapillary PH). Through poorly understood mechanisms, the increase in pulmonary venous pressure may cause a remodeling of the small pulmonary arteries with the development of a precapillary component that identifies a combined pre-post capillary PH. As pulmonary vascular resistance increases, right ventricular (RV) adaptation to the increased afterload may fail, and abnormal RV systolic function develops during exercise and at rest. The development of PH in patients affected by heart failure has a relevant prognostic impact, increasing morbidity and mortality; and, in particular, when associated with RV dysfunction, it represents an adverse clinical turning point in the history of the disease