Heart Failure Duration, Cardiac Remodeling, Dysfunction, and Hemodynamic Severity in HFpEF and HFmrEF

doi:10.1016/j.jchf.2026.103167

Heart failure & cardiomyopathiesSecondary analysis

Heart Failure Duration, Cardiac Remodeling, Dysfunction, and Hemodynamic Severity in Heart Failure with Preserved Ejection Fraction (HFpEF) and HFmrEF

JACC Heart FailPublished 5 Jun 2026

Secondary analysis of the REDUCE LAP-HF II randomised trial

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Authors' conclusion

Longer duration of HFpEF diagnosis is associated with more advanced cardiac remodeling and dysfunction and higher risk of worsening HF

Study context

Population: Patients with heart failure (HF), LVEF ≥40% and exercise pulmonary capillary wedge pressure ≥25 mm Hg
Participants: 626 patients

Comparison: HF duration >3 years vs 1-3 years vs <1 year

Primary result

As reported in the abstract

Cardiac structure/function and hemodynamics by HF duration

Biatrial myopathy

>3 years48.8%

1-3 years40.8%

<1 year28.2%

Resting PCWP elevation

>3 years75.8%

1-3 years70.7%

<1 year64.9%

Outcome	>3 years	1-3 years	<1 year
LV global longitudinal strain, median (Q1-Q3)	16.4% [Q1-Q3: 14.3%-18.6%]	17.7% [Q1-Q3: 15.4%-20.0%]	18.4% [Q1-Q3: 16.3%-20.5%]
RV free wall strain, median (Q1-Q3)	20.8% [Q1-Q3: 16.7%-24.6%]	22.2% [Q1-Q3: 17.6%-26.1%]	24.4% [Q1-Q3: 19.2%-27.2%]

Further findings

Outcome	Lower risk with >3 years ←→ Higher risk with >3 years	HR (95% CI)	P value
HF event risk		1.70 (1.17–2.48)	P = 0.006
	0.512Hazard ratio (log scale)

Atrial shunt response across duration groups

No significant heterogeneity in atrial shunt response across duration groups

Original publication

Heart Failure Duration, Cardiac Remodeling, Dysfunction, and Hemodynamic Severity in HFpEF and HFmrEF. JACC Heart Fail. Published 5 June 2026. doi:10.1016/j.jchf.2026.103167

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Summarised from the published abstract; every number is checked against it