This protocol covers patients with pulmonary hypertension arising from left heart disease in the specific setting of heart failure with preserved ejection fraction (HFpEF), defined as a left ventricular ejection fraction of 50% or greater. In this population, elevated left-sided filling pressures drive secondary increases in pulmonary arterial pressure.
The primary objectives are to lower filling pressures and reduce pulmonary arterial pressure by addressing the underlying left-heart pathophysiology.
Management focuses on control of blood pressure, volume load, and modifiable risk factors; an SGLT-2 inhibitor is part of the evidence-based regimen for a specific patient subset within this ejection-fraction range — the complete algorithm is available in the full protocol.
DOI: 10.1093/eurheartj/ehac237
In patients with HFpEF, blood pressure, volume load, and risk factors should be controlled, which may lower filling pressures and PAP.
Recently, the SGLT-2i empagliflozin improved outcomes in patients with an LV ejection fraction of 40–60%.
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