Problematic aspects of pulmonary hypertension due to left heart disease: focus on combined postcapillary and precapillary pulmonary hypertension

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Abstract

Рulmonary hypertension (PH) is a common complication of left heart diseases. In addition to a passive increase of pressure in the venous bed of the pulmonary circulation, leading to an increase of mean pulmonary pressure, signs of precapillary PH could be detected in some patients. Since 2013, a hemodynamic subtype of PH due to left heart diseases – combined post/precapillary PH has been identified, with a more unfavorable prognosis and high mortality.

About the authors

A. M. Aleevskaya

National Medical Research Center for Cardiology

Author for correspondence.
Email: aaleevskaya@mail.ru
ORCID iD: 0000-0001-6899-3481

клинический ординатор отд. легочной гипертензии и заболеваний сердца ФГБУ «НМИЦ кардиологии»

Russian Federation, Moscow

O. N. Vyborov

National Medical Research Center for Cardiology

Email: aaleevskaya@mail.ru
ORCID iD: 0000-0002-8181-2144

к.м.н., науч. сотр. отд. легочной гипертензии и заболеваний сердца ФГБУ «НМИЦ кардиологии»

Russian Federation, Moscow

V. V. Gramovich

National Medical Research Center for Cardiology

Email: aaleevskaya@mail.ru
ORCID iD: 0000-0003-3292-0912

к.м.н., ст. науч. сотр. отд. легочной гипертензии и заболеваний сердца ФГБУ «НМИЦ кардиологии»

Russian Federation, Moscow

T. V. Martynyuk

National Medical Research Center for Cardiology; Pirogov Russian National Research Medical University

Email: aaleevskaya@mail.ru
ORCID iD: 0000-0002-9022-8097

д.м.н., рук. отд. легочной гипертензии и заболеваний сердца ФГБУ «НМИЦ кардиологии», проф. каф. кардиологии ФДПО ФГАОУ ВО «РНИМУ им. Н.И. Пирогова»

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Hemodynamic criteria for PH due to pathology of the left heart.

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3. Fig. 2. Pathophysiological mechanisms of PH formation due to the pathology of the left chambers of the heart.

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4. Fig. 3. Histopathological changes in the vessels of the pulmonary circulation in PH due to pathology of the left heart: a - hypertrophy of the media, proliferative changes in the intima and adventitia of the distal pulmonary artery; b - hypertrophy of media, proliferative changes in the intima and adventitia of the distal pulmonary vein; c - recanalized thrombus in the pulmonary arteriole.

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5. Fig. 4. Algorithm for determining the need for invasive diagnostics in patients with probable PH due to pathology of the left heart.

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6. Fig. 5. Algorithm for the diagnosis of PH due to pathology of the left heart on the basis of KPOS data and determination of the pre-test probability.

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