Pulmonale Hypertonie bei Linksherzerkrankungen

Left heart disease (LHD) is the most common cause of pulmonary hypertension (PH), which is further categorised into isolated post-capillary PH (IpcPH) and combined pre- and post-capillary PH (CpcPH). With the aim of developing treatment strategies, the PH-LHD working group of the 7 ^thWorld Symposium on Pulmonary Hypertension placed a stronger focus on phenotyping, subtyping and a more differentiated approach to the broad spectrum of PH-LHD. With this intention, a four-stage PH-LHD system was developed in which each stage (A=risk, B=structural heart disease, C=symptomatic heart disease, D=advanced) is characterised by specific pathophysiological, haemodynamic, clinical and ultimately therapeutic strategies. In this context, attention is also paid to cardiac diseases leading to PH-LHD with specific therapeutic approaches, such as mitral and aortic valve stenosis and selected cardiomyopathies. The overlap with other PH groups such as CTEPH and PH in lung diseases is also emphasised and specified. The therapeutic use of PAH drugs that have a pulmonary vascular approach can still not be recommended outside of clinical trials.