Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction

PH is frequently seen in patients with HFpEF and is associated with significantly greater symptom burden and increased mortality. The echocardiogram remains the initial screening test for PH in HFpEF and can generate an initial impression of the type of PH present and RV function. The RHC is the test of choice to define PH-HFpEF, and also importantly, understand the underlying hemodynamic profile (IpcPH vs CpcPH). The use of pulmonary vasodilators in PH-HFpEF has been evaluated in multiple clinical trials with mixed results. There are currently no FDA-approved therapies for PH-HFpEF. There is a significant interest in finding an effective therapeutic option for this population and clinical trials are currently underway using novel mechanistic approaches in well-defined phenotypes. Improving the understanding of the different phenotypes and mechanisms of injury in each subset of patients with PH-HFpEF will be a critical step to improving the treatment in the future (Table 3).