Pulmonary vascular disease & thromboembolism
Multimodal Framework of Left Heart-Pulmonary Vascular Remodeling Underlying Right Ventricular Failure in PH-HFpEF
Main finding · 1-year outcomes (mortality or first heart failure hospitalization)Result — go to the resultHazard ratio 8.2 95% CI 2.5–25.4Authors' conclusion
This integrative methodological framework of vessel-specific wave mechanics and myocardial transcriptomics advances the mechanistic understanding of left heart-pulmonary vascular remodeling in PH-HFpEF.
Study context
- Population
- Patients with pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF)PH-HFpEF cohort, prospective subsets underwent additional assessments · pulmonary vascular mechanics (impedance and wave intensity analysis) 17 · 4-dimensional flow cardiac magnetic resonance imaging (MRI) 15 · endomyocardial biopsy with long-read RNA sequencing 10
- Participants
- 48 patients
- Exposure
- Right ventricular (RV) dysfunction subgroup compared with the normal RV subgroup
- RV dysfunction groupn = 19
- Normal RV function groupn = 29reference
- Outcome
- 1-year outcomes:
- Mortality
- First heart failure hospitalization
- Follow-up
- 1-year
Methodological detailspredominantly retrospective, prospective subset
- Predominantly retrospective
- Prospective subset
Main finding
As reported in the abstract
Hazard ratio
8.2
95% CI 2.5–25.4
RV dysfunction groupvs normal RV function group
hazard ratio 8.2 (95% CI 2.5–25.4)
Observational data: associations, not effects.
Further findings
Left ventricular longitudinal strain on cardiac MRI
- Impaired in the RV dysfunction subgroup compared with the normal RV subgroup
Pulmonary vascular mechanics
- Increased proximal pulmonary arterial stiffness (characteristic impedance), increased RV energy expenditure, and abnormal distal vascular reflections with exercise, indicating segmental pulmonary vascular remodeling
Four-dimensional flow MRI
- Disturbed flow patterns and trends toward increased viscous energy loss across the left heart and pulmonary circulation
Myocardial transcriptomics
- Global gene differences were minimal
- Upregulation of RNA metabolism and downregulation of mitochondrial pathways in the RV dysfunction subgroup
- Selective isoform expression in key cardiac genes
- Likely reflecting the limited statistical power for detecting individual differentially expressed genes in this modest cohort
Original publication
Multimodal Framework of Left Heart-Pulmonary Vascular Remodeling Underlying Right Ventricular Failure in PH-HFpEF. Circ Heart Fail. Published 24 August 2026. doi:10.
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