Heart Failure Seminar: Focus on Pulmonary Hypertension and Right Heart Failure - OnDemand-Focus on Pulmonary Hypertension and Right Ventricular Heart Failure

Video Transcription

Video Summary

The webinar “The Pressure’s On: A Guide to Pulmonary Hypertension (PH) Diagnosis and Management in 2025” presented updates following the Seventh World Symposium on Pulmonary Hypertension. Experts reviewed PH's classification, diagnosis, risk stratification, and treatment, emphasizing recent guideline changes.<br /><br />Dr. Tom Cassino outlined PH’s types: Group 1 (pulmonary arterial hypertension, PAH), a rare vascular disease, and Group 2 (PH related to left heart disease), the most common form affecting millions globally. Diagnosis relies heavily on echocardiography for assessing right heart structure and pressures, but definitive diagnosis requires right heart catheterization. The updated PH hemodynamic definition now uses a mean pulmonary artery pressure >20 mmHg and pulmonary vascular resistance >2 Wood units. Phenotyping patients into pre-capillary, post-capillary, or combined forms guides treatment and prognosis.<br /><br />Dr. Kevin Kissling reviewed pharmacotherapy for Group 1 PAH, detailing a two-tier risk-based initial treatment: high-risk patients require intravenous or subcutaneous prostacyclin therapy (often alongside endothelin receptor antagonists and PDE5 inhibitors), while non-high-risk patients start dual oral therapy with ERA and PDE5 inhibitors. The novel agent sotatercept, an activin signaling inhibitor, has shown significant improvements in hemodynamics, exercise capacity, and clinical outcomes, especially as add-on therapy for intermediate-to-high risk patients. Monitoring for side effects such as bleeding and hemoglobin changes is essential.<br /><br />Dr. Harden discussed PH in left heart disease (Group 2), distinguishing isolated post-capillary PH from combined pre- and post-capillary PH, which involves pulmonary vascular remodeling and worsens prognosis. Advanced heart failure therapies including LVADs can reduce PH severity and enable transplantation eligibility. Unlike Group 1 PAH, pulmonary vasodilators have not demonstrated benefit in Group 2 PH.<br /><br />Nurse practitioner Jennifer Ashby addressed Group 4 PH, chronic thromboembolic pulmonary hypertension (CTEPH), emphasizing its treatable and potentially curable nature. Diagnosis requires persistent perfusion defects on VQ scan despite anticoagulation, confirmed hemodynamically by right heart cath. Surgery (pulmonary thromboendarterectomy) is the definitive treatment for proximal disease; balloon pulmonary angioplasty and medical therapy with riociguat are options for inoperable or persistent cases. Lifelong anticoagulation is mandatory.<br /><br />Overall, the panel stressed individualized diagnosis incorporating clinical, imaging, and hemodynamic data to guide management across PH groups, highlighting new therapies like sotatercept for Group 1 PAH and the importance of specialist referral for complex cases like CTEPH. Risk assessment tools remain key to optimizing treatment and improving survival.

Keywords

Pulmonary Hypertension

PH Diagnosis

PH Management

World Symposium on Pulmonary Hypertension

Group 1 PAH

Group 2 PH

Group 4 CTEPH

Echocardiography

Right Heart Catheterization

Hemodynamic Definition

Risk Stratification

Pharmacotherapy

Sotatercept

Pulmonary Thromboendarterectomy