{"doi":"10.1002/ehf2.12565","title":"Diffuse Right Ventricular Fibrosis in Heart Failure with Preserved Ejection Fraction and Pulmonary Hypertension","abstract":"Abstract Aims While right ventricular (RV) dysfunction is associated with worse prognosis in co-morbid pulmonary hypertension and heart failure with preserved ejection fraction (PH-HFpEF), the mechanisms driving RV dysfunction are unclear. We evaluated the extent and clinical correlates of diffuse RV myocardial fibrosis in PH-HFpEF, as measured by cardiovascular magnetic resonance-derived extracellular volume (ECV). Methods and results We prospectively enrolled participants with PH-HFpEF (n = 14), pulmonary arterial hypertension (PAH; n = 13), and controls (n = 8). All participants underwent high-resolution cardiovascular magnetic resonance, and case subjects (PH-HFpEF and PAH) additionally underwent right heart catheterization. T1 mapping was performed using high-resolution modified look-locker inversion recovery with a 1 × 1 mm2 in-plane resolution. RV free wall T1 values were quantified, and ECV was calculated. Participants with PH-HFpEF were older and carried higher rates of hypertension and obstructive sleep apnoea than those with PAH. While RV ECV was similar between PH-HFpEF and PAH (33.1 ± 8.0 vs. 34.0 ± 4.5%; P = 0.57), total pulmonary resistance was lower in PH-HFpEF compared with PAH [PH-HFpEF: 5.68 WU (4.70, 7.66 WU) vs. PAH: 8.59 WU (8.14, 12.57 WU); P = 0.01]. RV ECV in PH-HFpEF was associated with worse indices of RV structure (RV end-diastolic volume: r = 0.67, P = 0.01) and RV function (RV free wall strain: r = 0.59, P = 0.03) but was not associated with RV afterload (total pulmonary resistance: r = 0.08, P = 0.79). Conversely, there was a strong correlation between RV ECV and RV afterload in PAH (r = 0.57, P = 0.04). Conclusions Diffuse RV fibrosis, as measured by ECV, is present in PH-HFpEF and is associated with adverse RV structural and functional remodelling but not degree of pulmonary vasculopathy. In PH-HFpEF, diffuse RV fibrosis may occur out of proportion to the degree of RV afterload.","journal":"ESC Heart Failure","year":2020,"id":60503,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":61,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9619,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":254097,"name":"Emily Li","orcid":"0000-0002-0921-1344","position":1,"is_corresponding":false},{"id":319739,"name":"Brandon Benefield","orcid":"0000-0002-4394-2300","position":2,"is_corresponding":false},{"id":319740,"name":"Stanley Swat","orcid":"0000-0002-3736-7434","position":3,"is_corresponding":false},{"id":319741,"name":"Vincenzo B. Polsinelli","orcid":"0000-0002-8484-2664","position":4,"is_corresponding":false},{"id":319742,"name":"James Carr","orcid":"0000-0003-1380-8095","position":5,"is_corresponding":false},{"id":235994,"name":"Sanjiv J. Shah","orcid":"0000-0002-5655-8201","position":6,"is_corresponding":false},{"id":319743,"name":"Michael Markl","orcid":"0000-0002-7686-1128","position":7,"is_corresponding":false},{"id":319744,"name":"Jeremy D. Collins","orcid":"0000-0003-0707-1736","position":8,"is_corresponding":false},{"id":319745,"name":"Benjamin H. Freed","orcid":"0000-0003-1075-5047","position":9,"is_corresponding":false},{"id":319738,"name":"Ravi B. Patel","orcid":"0000-0001-5037-5554","position":0,"is_corresponding":true}],"reference_count":23,"raw_metadata":null,"created_at":"2026-07-18T21:09:05.493770Z","pmid":"31903694","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}