AUTHOR=Maeder Micha T. , Weber Lukas , Buser Marc , Brenner Roman , Joerg Lucas , Rickli Hans 

TITLE=Pulmonary Hypertension in Patients With Heart Failure With Mid-Range Ejection Fraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.694240

DOI=10.3389/fcvm.2021.694240

ISSN=2297-055X

ABSTRACT=Pulmonary hypertension (PH) is common in patients with heart failure (HF). The role of PH in patients with HF with reduced (HFrEF) and preserved (HFpEF) left ventricular ejection fraction has been extensively characterized during the last years. However, the pathophysiology of HF with mid-range LVEF (HFmrEF), and in particular the role of PH in this context, are largely unknown. Given the paucity of data in this field the prevalence of PH, the underlying mechanisms, and the optimal therapy remain speculative. Although often studied together there is increasing evidence that HFpEF and HFmrEF differ significantly, which may also have implications for the pathophysiology of PH in these two conditions. The present review provides a summary of the current knowledge of the mechanisms and clinical impact of PH in patients with HFmrEF, the non-invasive and invasive diagnostic approach required to define the pathophysiology of PH and its management, and recent insights regarding management from mechanistic studies and randomized trials. We also provide an outlook regarding gaps in evidence, future clinical challenges, and research opportunities.