The difficult diagnosis of pulmonary vascular disease in heart failure

In this issue of the European Respiratory Journal (ERJ), Gerges et al. [1] propose an interesting refinement of the diagnosis of pulmonary vascular disease in patients with left heart failure. The problem is of importance. Left heart disease with increased pulmonary venous pressure, abbreviated as LHD in recent reviews and guidelines, is by far the most common cause of pulmonary hypertension (PH) [2-4]. Furthermore, up to 80% of patients with heart failure with preserved or reduced ejection fraction and/or mitral or aortic valve diseases are exposed to the eventual development of PH with associated worsened symptomology and decreased survival [2-4].