Pulmonary vascular disease & thromboembolismCohort study
Multimodal Framework of Left Heart-Pulmonary Vascular Remodeling Underlying Right Ventricular Failure in PH-HFpEF
- 2-step study
- predominantly retrospective
- prospective subset
Authors' 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
Main finding
As reported in the abstract
1-year outcomes:
- Mortality
- First heart failure hospitalization
Hazard ratio
8.2
95% CI 2.5–25.4
RV dysfunction group vs 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:10.1161/circheartfailure.126.014620
Summarised from the published abstract; every number is checked against it