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PH-LHD develops mainly due to the sustained elevation of left-sided filling pressure because of left-ventricular (LV) dysfunction, producing an increase in pulmonary arterial pressure and subsequently pulmonary vascular remodeling [28]
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The documented mechanisms are: VEGF stimulation in dermal fibroblasts that supports the microvascular network feeding the follicle, collagen and glycosaminoglycan synthesis at the follicular basement membrane, anti-inflammatory signaling that calms the chronic micro-inflammation associated with androgenetic alopecia, and direct follicular signaling that extends the anagen growth phase
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