Introduction: Patients with combined post- and pre-capillary pulmonary hypertension (CpcPH) due to left heart disease (PH-LHD) have worse prognosis compared with isolated post-capillary (IpcPH). Because patients with CpcPH usually have more severe PH than IpcPH, it remains unclear if increased mortality is a result of pulmonary vascular pathology or simply due to higher total right ventricular (RV) load. RV effective arterial elastance [Ea; end-systolic pressure (ESP) /stroke volume (SV)] is a measure of total RV afterload, reflecting both resistive and pulsatile components. In PH, ESP is best approximated by systolic pulmonary artery pressure (SPAP), and therefore Ea is defined as SPAP/SV. Objectives: To evaluate if RV Ea predicts survival in PH-LHD and whether variables associated with pulmonary vascular pathology (pulmonary vascular resistance (PVR), transpulmonary gradient (TPG), diastolic pulmonary gradient (DPG)) are predictors of mortality after controlling for total RV load. Methods: Out of 1236 p...