Pulmonary hypertension in aortic valve stenosis

In patients with severe aortic stenosis (AS), pulmonary hypertension (PH) typically is indicative of a de compensated disease state with exhausted compensatory mechanisms of the left ventricle, meaning a heart failure state resulting from AS-related cardiac injury. In the present review article, we discuss new insights into the pathophysiology of AS-induced PH, the prognostic impact, and potential options to prevent and treat PH in this setting. We emphasize recent data from studies focused on invasive hemodynamics in patients with severe AS that are being evaluated for aortic valve replacement, particularly the key relevance of combined pre-and post-capillary PH. This latter represents an advanced form of cardiac injury that is often associated with right ventricular dysfunction and poor prognosis. Given this context, we highlight the relevance of performing right heart catheterization in combination with non-invasive imaging for the comprehensive assessment of AS patients that are being evaluated for aortic valve replacement. Such comprehensive assessment plays a key role not only to precisely define the extent of AS-related cardiac injury but also to distinguish those PH forms that are unrelated to AS. (c) 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

In patients with severe aortic stenosis, pulmonary hypertension is a sign of decompensated cardiac function and heart failure resulting from AS-related cardiac injury. This review article discusses the pathophysiology of AS-induced PH, its prognostic impact, and options for prevention and treatment. The study emphasizes the importance of invasive hemodynamics in evaluating AS patients for aortic valve replacement, particularly the relevance of combined pre-and post-capillary PH. Comprehensive assessment, including right heart catheterization and non-invasive imaging, is crucial for accurately evaluating AS-related cardiac injury and distinguishing PH forms unrelated to AS.