Quite obviously as left heart filling pressure rises or when it has systolic failure the contribution of pulm venous pressure to pulmonary artery pressure rises and PVR increases. Lately, the diastolic pressure difference (diastolic mPAP - PAWP) > 7 mmHg is a better indicator than transpulmonary systolic gradient > 12mmHg of post-capillary + pre capillary (disproportionate / reactionary) pulmonary artery hypertension in left heart diseases. A DPD < 7 mmHg indicates only post-capillary (passive) hypertension. In a study, when PVR < 2 Wood U, then pulm venous contribution was low, as the DPD < 5 mmHg in 94% patients. In those with PVR >2 Wood U, the DPD was > 5 mmHg in 50% patients.
If the pulmonaries veins have normal anatomy, the participation in pulmonary artery hypertension is a manifestation of the left ventricle or left atriun dysfunction.
it depends on whether you have a precapillary (idiopathic, CTEPH) or postcapillary (due to left heart failure) PAH
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