Pulmonary Hypertension in Left Heart Disease

Inclusion Criteria:

• Patients referred to the cardiac catheterization laboratory for invasive right heartcatheterization for any reason.

• Left Heart Disease, defined as one (or more) of the following:

• Symptomatic HFpEF, defined by signs and symptoms of HF (dyspnea, fatigue),normal left ventricular (LV) EF (≥50% within 12 months of enrollment), andobjective evidence of HF fulfilling at least one of the following criteria:Prior hospitalization for decompensated HF treated with intravenous diuretics;Invasively verified HFpEF defined by pulmonary capillary wedge pressure (PCWP)of ≥15 mmHg at rest and/or ≥25 mmHg during exercise; Clinical diagnosis ofHFpEF that does not meet criteria i. or ii. but verified with NTproBNP>300pg/ml in sinus rhythm or >900 pg/ml in AF; H2FPEF score ≥6 or HFA-PEFF score≥5according to current guidelines.

• Symptomatic HFrEF, defined by defined by signs and symptoms of HF (dyspnea,fatigue) and reduced EF (<50%).

• Symptomatic valvular heart disease (VHD), defined by signs and symptoms of HF (dyspnea, fatigue) in tandem with clinically significant aortic or mitral valvedisease (regurgitation and/or stenosis).

Exclusion Criteria:

• Patient inability or unwillingness to undergo noninvasive echocardiography, or ifechocardiography would, in the opinion of the investigator, somehow compromise thequality of data acquisition for the clinical case.

• WSPH Group 1 Pulmonary hypertension or PH (Pulmonary arterial hypertension;including congenital heart disease)

• Group 3 PH (Hypoxia/Lung disease-related PH)

• Group 4 PH (Thromboembolic PH)

• Group 5 PH (Miscellaneous)

• Clinically significant parenchymal lung disease, hypoxemia, or lung infection

• Amyloid/infiltrative cardiomyopathy

• Acute Myocarditis

• Acute coronary syndrome or revascularization within 90 days

• Use of PH-specific drugs

• Constrictive pericarditis

• High output heart failure

• HF hospitalization within the preceding 30 days

• Severe or greater aortic (AVA < 1.0 cm2, Mean Gradient > 40 mmHg) or severe mitral (MVA < 1.0 cm) stenosis

• Inability or unwillingness to exercise

• Inadequate echocardiographic imaging windows

• Inability or unwillingness to cooperate with breath holding