Strategies for the Diagnosis and Management of Combined Post- and Pre-Capillary Pulmonary Hypertension (Cpc-PH) in Patients With HF in Need of Advanced Therapies: When the Pressure Is High

Combined post- and pre-capillary pulmonary hypertension (Cpc-PH) represents a high-risk phenotype in patients with heart failure and significantly impacts prognosis, transplant candidacy, and advanced therapy decisions. Accurate classification requires careful hemodynamic assessment; however, distinguishing reversible pulmonary vascular changes from fixed remodeling remains challenging.

This session will provide a practical framework for diagnosing and managing Cpc-PH across the spectrum of heart failure care. Faculty will review contemporary invasive hemodynamic assessment and interpretation, followed by a discussion of pulmonary vascular remodeling and its implications for reversibility. The role of acute vasodilator testing in risk stratification and transplant evaluation will be addressed.

Management strategies will span chronic and advanced care, including emerging data on targeted pulmonary vascular therapies in selected Group 2 and Cpc-PH patients, as well as acute hemodynamic optimization, inotropic support, durable LVAD implantation, and transplant considerations.

Learning Objectives

• Understand the diagnosis of combined post- and pre-capillary pulmonary hypertension (Cpc-PH) using contemporary hemodynamic assessments.
• Use hemodynamic profiling and acute vasodilator testing to risk-stratify patients with Cpc-PH and inform advanced heart failure decision-making.
• Develop an approach to chronic medical management strategies for Group 2/Cpc-PH, as well as acute and advanced therapies, including inotropes, LVAD support, and transplant considerations.