MODULATING THE NITRIC OXIDE – CYCLIC GMP PATHWAY IN THE PRESSURE OVERLOADED LEFT VENTRICLE AND GROUP II PULMONARY HYPERTENSION

摘要

Group II pulmonary hypertension commonly occurs in the setting of a pressure overloaded left ventricle that is also conducive to the development heart failure with preserved ejection fraction. Population trends and a high prevalence of underlying causative conditions, such as essential hypertension or aortic stenosis, have increased awareness of the pressure overloaded left ventricle and associated Group II pulmonary hypertension. Patients often exhibit poor exercise tolerance and signs of heart failure indistinguishable from systolic heart failure; but effective medical treatments in this area have been lacking. Recent pre-clinical work has shed light on how the down-regulated nitric oxide – cyclic GMP pathway (within the myocardium and pulmonary vasculature) contributes to the pathophysiology of these associated conditions. This article will discuss the impact of the nitric oxide – cyclic GMP pathway on the pathogenesis of the pressure overloaded left ventricle and Group II pulmonary hypertension, and will also introduce the potential therapeutic value of modulating this pathway.