Heart failure & cardiomyopathiesCohort study
Myocardial Histopathology-Based Heart Failure Phenotyping
- Retrospective cohort study
- single-centre pathologist blinded to clinical data
- prespecified histogroups
Authors' conclusion
Integrated assessment of fibrosis and hypertrophy identifies clinically and prognostically distinct histogroups in HFpEF, but not in HFrEF.
Study context
- Population
- Patients with heart failure (HF) who underwent right ventricular endomyocardial biopsy, 1999 to 2023, excluding transplant, infiltrative, inflammatory and hypertrophic cardiomyopathy
- Participants
- 124 vs 170
- Exposure
- Histogroups defined by fibrosis and hypertrophy, in heart failure with preserved ejection fraction (HFpEF) vs HFrEF
- HFpEFn = 124
- HFrEFn = 170
- Outcome
- All-cause mortality by histogroup
- Follow-up
- 10 years
Main finding
As reported in the abstract
10-year all-cause mortality, severe vs mild histogroup
Hazard ratio
2.3
95% CI 1.05–4.9
P = 0.037
Severe histogroup vs Mild histogroup
HR 2.3 (95% CI 1.05–4.9); P = 0.037
- Prognostic association differed by HF phenotype
- adjusted interaction P = 0.034
Observational data: associations, not effects.
Further findings
Clinical profile across histogroups (HFpEF)
- More advanced histogroups: more men, diabetes, higher NT-proBNP, lower LVEF, greater LV mass index
- P < 0.05 for all
- Most other clinical and hemodynamic characteristics similar
Original publication
Myocardial Histopathology-Based Heart Failure Phenotyping. JACC Heart Fail. Published 28 August 2026. doi:10.1016/j.jchf.2026.103369
Summarised from the published abstract; every number is checked against it