Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatments for PH-LHF, despite the high number of drugs tested so far. This scientific document addresses the main knowledge gaps in PH-LHF with emphasis on pathophysiology and clinical trials. Key identified issues include better understanding of the role of pulmonary venous versus arteriolar remodelling, multidimensional phenotyping to recognize patient subgroups positioned to respond to different therapies, and conduct of rigorous pre-clinical studies combining small and large animal models. Advancements in these areas are expected to better inform the design of clinical trials and extend treatment options beyond those effective in pulmonary arterial hypertension. Enrichment strategies, endpoint assessments, and thorough haemodynamic studies, both at rest and during exercise, are proposed to play primary roles to optimize early-stage development of candidate therapies for PH-LHF.

中文翻译：

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左心衰竭相关肺动脉高压的治疗发现路线图。 ESC 心力衰竭协会 (HFA) 和 ESC 肺循环和右心室功能工作组的科学声明

与左心衰竭 (LHF) (PH-LHF) 相关的肺动脉高压 (PH) 是 PH 最常见的原因之一。它直接导致症状和功能能力下降并对右心功能产生负面影响，最终导致预后不良。尽管迄今为止测试了大量药物，但尚无针对 PH-LHF 的具体治疗方法。这份科学文件解决了 PH-LHF 的主要知识差距，重点是病理生理学和临床试验。已确定的关键问题包括更好地了解肺静脉与小动脉重塑的作用、识别对不同治疗有反应的患者亚组的多维表型分析，以及结合小型和大型动物模型进行严格的临床前研究。这些领域的进步预计将为临床试验的设计提供更好的信息，并将治疗方案扩展到肺动脉高压以外的有效治疗方案。建议在休息和运动期间进行富集策略、终点评估和彻底的血流动力学研究，以优化 PH-LHF 候选疗法的早期开发。