Disclosures Teaching grants and honoraria from Actelion Amgen

What is Pulmonary Hypertension ? An haemodynamic definition Pressure Mean PAP > 25 mm.

Progress in Cardiovascular Diseases 2011; 54: 154 -167.

LHD-CHD 3, 5% 10% 1, 5% 78% 7% Adapted from Galiè N. ESC 2009

Pathophysiology of Group 2 pulmonary hypertension. Copyright © American Heart Association Georgiopoulou V V

Factors associated with a higher probability of PH due to LHD Clinical features Echocardiography

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Disclosures Teaching grants and honoraria from: Actelion, Amgen, Bayer, Elpen, Menarini, MSD, Novartis, Pfizer, Sanofi and Servier.

Eur Heart J 2016: 37, 67 -119.

Clin Chest Med 2007; 28: 233 -241.

What is Pulmonary Hypertension ? An haemodynamic definition Pressure Mean PAP > 25 mm. Hg (rest) Extensive literature search* found N=14+2. 3 mm. Hg – upper limit 20+2 mm. Hg m. PAP < 20 mm. Hg – Normal m. PAP 21 -24 mm. Hg – Borderline m. PAP > 25 mm. Hg – Pulmonary hypertension * Olschewski et al. 4 th World Congress on PAH, Dana Point Ca, Feb 2008

Eur Heart J 2016: 37, 67 -119.

Eur Heart J 2009; 30: 2493 -2537.

Progress in Cardiovascular Diseases 2011; 54: 154 -167.

LHD-CHD 3, 5% 10% 1, 5% 78% 7% Adapted from Galiè N. ESC 2009 Gabbay et al. ATS 2007

Circ Heart Fail. 2013; 6: 344 -354.

Circulation 2012; 126: 975 -990.

Circ Heart Fail. 2013; 6: 584 -593.

Circulation 2012; 126: 975 -990.

J Am Coll Cardiol 2017: 69, 1718 -1734.

J Am Coll Cardiol 2017: 69, 1718 -1734.

Eur Heart J 2016: 37, 67 -119.

Factors associated with a higher probability of PH due to LHD Clinical features Echocardiography Interim evaluation Age > 65 Elevated systolic BP Elevated pulse pressure Obesity, metabolic syndrome Coronary artery disease Diabetes mellitus Atrial fibrillation Left atrial enlargement Concentric remodelling of the LV Echocardiographic indicators of elevated LV filling pressure Symptomatic response to diuretics Exaggerated increase in BP during exercise Chest X-ray consistent with HF Galiè et al. Eur Heart J 2009

Eur Heart J 2016: 37, 67 -119.

Clin Chest Med 2007; 28: 233 -241.

Heart Failure Clin 2012; 8: 447 -459.

Circ Heart Fail. 2013; 6: 584 -593.

Heart Failure Clin 2012; 8: 447 -459.

Eur Heart J 2016: 37, 67 -119.

Eur Heart J 2017: 38, 2869 -2873.