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Furthermore, the pathobiology of PH-LHD is not well understood, although pulmonary vascular remodeling is thought to result from (1) increased wall stress due to increased left atrial pressures; (2) hemodynamic congestion-induced decreased shear stress in the pulmonary vascular bed; (3) comorbidity-induced endothelial dysfunction with direct injury to the pulmonary microvasculature; and (4) superimposed pulmonary arterial hypertension risk factors. To ultimately be able to modify disease, either by prevention or treatment, a better understanding of the various drivers of PH-LHD, including endothelial dysfunction, abnormalities in vascular tone, platelet aggregation, inflammation, adipocytokines, and systemic complications (including splanchnic congestion and lymphatic dysfunction) must be further investigated. Here, we review the diagnostic criteria and various hemodynamic phenotypes of PH-LHD, the potential biological mechanisms underlying this disorder, and pressing questions yet to be answered about the pathobiology of PH-LHD.<\/jats:p>","DOI":"10.1161\/circresaha.122.319967","type":"journal-article","created":{"date-parts":[[2022,4,28]],"date-time":"2022-04-28T14:02:54Z","timestamp":1651154574000},"page":"1382-1403","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Understanding the Pathobiology of Pulmonary Hypertension Due to Left Heart Disease"],"prefix":"10.1161","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2063-4193","authenticated-orcid":true,"given":"Jessica H.","family":"Huston","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 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