Pulmonary hypertension (PH) is a common condition in patients with left heart disease (LHD) that is highly relevant for morbidity and mortality. While post-capillary in nature, the pathophysiology of PH in patients with LHD (heart failure/cardiomyopathy, valvular heart disease; other: congenital/acquired) is complex, and decisions about management strategies are challenging. Recently, the updated European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and treatment of PH revisited hemodynamic definitions and the sub-classification of post-capillary PH, and provided numerous new recommendations on the diagnosis and management of PH associated with various types of LHD. Here, we review several novel aspects that focus on: (a) updated hemodynamic definitions, including the distinction between isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH); (b) the pathogenesis of PH-LHD, considering various components contributing to PH, such as pulmonary congestion, vasoconstriction, and vascular remodeling; (c) the prognostic relevance of PH and hemodynamic markers; (d) the diagnostic approach to PH-LHD; (e) management strategies in PH-LHD, distinguishing between targeting the underlying left heart condition, the pulmonary circulation, and/or impaired right ventricular function. In conclusion, precise clinical and hemodynamic characterization and detailed phenotyping are essential for prognostication and the management of patients with PH-LHD.

肺动脉高压（PH）是左心疾病（LHD）患者的常见病症，与发病率和死亡率高度相关。虽然本质上是毛细血管后PH，但 LHD（心力衰竭/心肌病、瓣膜性心脏病；其他：先天性/后天性）患者 PH 的病理生理学很复杂，有关管理策略的决策具有挑战性。最近，欧洲心脏病学会/欧洲呼吸学会更新的PH诊断和治疗指南重新审视了血流动力学定义和毛细血管后PH的亚分类，并对各种类型相关PH的诊断和治疗提供了许多新的建议左舵驾驶。在这里，我们回顾了几个新的方面，重点关注：（a）更新的血流动力学定义，包括孤立的毛细血管后 PH（IpcPH）和组合的毛细血管后和前 PH（CpcPH）之间的区别；(b) PH-LHD 的发病机制，考虑导致 PH 的各种因素，例如肺充血、血管收缩和血管重塑；(c) PH 和血流动力学标志物的预后相关性；(d) PH-LHD 的诊断方法；(e) PH-LHD 的管理策略，区分针对潜在的左心病症、肺循环和/或受损的右心室功能。总之，精确的临床和血流动力学特征以及详细的表型分析对于 PH-LHD 患者的预后和治疗至关重要。