Beraprost is used to treat peripheral chronic arterial occlusive disease. However, the efficacy and safety of beraprost in patients with pulmonary hypertension (PH) due to left ventricular systolic dysfunction (PH-HFrEF) remains unknown. The primary objective of this study was to determine the effects of beraprost on PH-HFrEF.We prospectively recruited patients with PH-HFrEF as determined by echocardiography and right cardiac catheterization. Beraprost sodium was given orally (1?μg/kg/d) added to the usual treatment, and patients were evaluated at 1-year follow-up.Twenty-five patients were recruited with baseline systolic pulmonary artery pressure (PAP) of 49.5?±?10.8?mm Hg. Systolic PAP results at 3, 6, 9, and 12 months were 39.1?±?8.1, 30.4?±?5.2, 27.7?±?3.0, and 27.0?±?4.7?mm Hg, respectively, which were all significantly lower than systolic PAP at baseline (P?<?.05). Left ventricular ejection fraction results at 6 months (43.5?±?7.0%), 9 months (47.0?±?5.5%), and 12 months (48.2?±?4.8%) were significantly higher than at baseline (34.7?±?9.2%) (P?<?.05). Six-minute walking distance at 3 months (282.8?±?80.6?m), 6 months (367.1?±?81.2?m), 9 months (389.8?±?87.1?m), and 12 months (395.7?±?83.4?m) increased with time, and all were significantly higher than baseline (190.1?±?75.5?m) (P?<?.05). One patient developed atrial fibrillation and recovered to sinus rhythm after intravenous administration of amiodarone. There were no instances of cardiac-related death, severe bleeding, or severe impairment of liver function.Routine oral administration of beraprost sodium added to the usual treatment may improve cardiopulmonary hemodynamics and exercise capacityin patients with PH-HFrEF.