November 29, 2025
Background: Pulmonary hypertension (PH) can develop from multiple etiologic mechanisms and disease states. Left-sided heart disease (LHD) is the most common cause of PH. Given the high prevalence of LHD and the prognostic implications of PH, early diagnosis is essential.
Review: Recent revisions have lowered the diagnostic thresholds for mean pulmonary arterial pressure and pulmonary vascular resistance to facilitate earlier diagnosis. Despite these updated criteria, current indications for right heart catheterization remain largely focused on identifying advanced disease. Proven vasodilator therapies for pulmonary arterial hypertension have not demonstrated meaningful benefit in the management of PH associated with LHD. This is largely because multiple pathophysiological mechanisms and comorbidities can independently contribute to the development of PH in individual patients.
Conclusions: Improved understanding and identification of distinct PH phenotypes in patients with left heart disease are essential for developing effective treatment strategies. Molecular pathways that contribute to the progression and irreversibility of PH may provide promising targets for future pharmacologic therapies.
Keywords: pulmonary hypertension; left heart disease.
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