ROCHESTER, MN — A new study proposed that pathophysiologic features associated with increased risk in heart failure with preserved ejection fraction (HFpEF) might reflect distinct phenotypes or disease stages related to heart failure (HF) duration and then set out to document that.
The international study led by the Mayo Clinic in Rochester, NY, aimed to determine how duration of HF diagnosis influences cardiac structure and function, hemodynamics, risk for worsening HF, and treatment response. The Ralph H. Johnson VA Health System in Charleston, SC, and the Ann Arbor, MI, VA Health System were among the participants in the research.
The study team evaluated baseline cardiac structure and function, hemodynamics and outcomes following randomization in the REDUCE LAP-HF II trial, which included 626 patients with HF, left ventricular ejection fraction ≥40%, and exercise pulmonary capillary wedge pressure ≥25 mm Hg, Participants were categorized by HF duration: <1 year, 1-3 years, and >3 years in the research published in JACC Heart Failure.1
Results indicated that longer HF duration was associated with greater cardiac remodeling and dysfunction, including lower left ventricular global longitudinal strain (16.4% [Q1-Q3: 14.3%-18.6%] vs. 17.7% [Q1-Q3: 15.4%-20.0%] vs. 18.4% [Q1-Q3: 16.3%-20.5%]; P < 0.0001) and right ventricular free wall strain (20.8% [Q1-Q3: 16.7%-24.6%] vs. 22.2% [Q1-Q3: 17.6%-26.1%] vs. 24.4% [Q1-Q3: 19.2%-27.2%]; P < 0.0001), and more biatrial myopathy (48.8% vs 40.8% vs. 28.2%; P < 0.0001).
“Resting pulmonary capillary wedge pressure elevation was more common with longer duration (75.8% vs 70.7% vs. 64.9%; P = 0.024),” according to the authors, who added, “These findings were confirmed in an independent sample of patients with HFpEF undergoing evaluation at Mayo Clinic. HF event risk increased with longer duration (HR: 1.70 [95% CI: 1.17-2.48]; P = 0.006 for >3 years vs. <1 year). No significant heterogeneity in atrial shunt response was observed across duration groups.”
The study team concluded that their findings underline “the priority for earlier diagnosis to improve outcomes. (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure [REDUCE LAP-HF TRIAL II].”
- Doi S, Kazui S, Akashi N, Patel RB, et. Al. Heart Failure Duration, Cardiac Remodeling, Dysfunction, and Hemodynamic Severity in HFpEF and HFmrEF: Insights From REDUCE LAP-HF II. JACC Heart Fail. 2026 Jun 5:103167. doi: 10.1016/j.jchf.2026.103167. Epub ahead of print. PMID: 42268170.
