Peikert, Alexander;
Fontana, Marianna;
Solomon, Scott D;
Thum, Thomas;
(2025)
Left ventricular hypertrophy and myocardial fibrosis in heart failure with preserved ejection fraction: mechanisms and treatment.
European Heart Journal
, Article ehaf524. 10.1093/eurheartj/ehaf524.
(In press).
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Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and is characterized by phenotypical heterogeneity with a high prevalence of multiple, often overlapping cardiometabolic disorders. Comorbidities such as hypertension, obesity, or diabetes are present in many HFpEF patients and are hypothesized to contribute to adverse cardiac remodelling and myocardial fibrosis through a variety of haemodynamic and metabolic impairments, with nearly half of all HFpEF patients exhibiting left ventricular (LV) hypertrophy or concentric remodelling. Myocardial fibrosis and its surrogate changes in LV structure and geometry lead to functional impairments such as increased diastolic stiffness and elevated filling pressures and are associated with reduced exercise tolerance and poor prognosis in patients with HFpEF. Despite recent therapeutic progress, there are currently no evidence-based therapies mechanistically focusing solely on myocardial fibrosis and LV hypertrophy in HFpEF. Recognizing myocardial fibrosis and LV hypertrophy as key features of the heterogeneous HFpEF pathophysiology may contribute to the development of promising targets for future clinical trials. This review elaborates on the pathophysiological role of fibrotic remodelling and LV hypertrophy in HFpEF, outlines contemporary diagnostic standards, and discusses emerging therapeutic strategies, aiming at directly modulating myocardial fibrosis and hypertrophy in HFpEF.
| Type: | Article |
|---|---|
| Title: | Left ventricular hypertrophy and myocardial fibrosis in heart failure with preserved ejection fraction: mechanisms and treatment |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/eurheartj/ehaf524 |
| Publisher version: | https://doi.org/10.1093/eurheartj/ehaf524 |
| Language: | English |
| Additional information: | © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Cardiac remodelling, Heart failure with preserved ejection fraction, Left ventricular hypertrophy, Myocardial fibrosis |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10213286 |
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