[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-433330-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-433330-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","left-ventricular-hypertrophy-and-myocardial-fibrosis-in-heart-failure-with-preserved-ejection-fraction-mechanisms-and-treatment","Left ventricular hypertrophy and myocardial fibrosis in heart failure with preserved ejection fraction - mechanisms and treatment","","Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and shows marked phenotypic heterogeneity, with many patients sharing overlapping cardiometabolic disorders. Hypertension, obesity, and diabetes are common and can promote adverse cardiac remodelling and myocardial fibrosis through haemodynamic and metabolic dysfunction. About half of HFpEF patients demonstrate left ventricular hypertrophy or concentric remodelling, which contributes to increased diastolic stiffness and higher filling pressures, impairing exercise tolerance and cardiovascular outcomes.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/left-ventricular-hypertrophy-and-myocardial-fibrosis-in-heart-failure-with-preserved-ejection-fraction-mechanisms-and-treatment/433330/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/left-ventricular-hypertrophy-and-myocardial-fibrosis-in-heart-failure-with-preserved-ejection-fraction-mechanisms-and-treatment/433330.png","ImageObject",300,407,{"name":42,"@type":43},"mieayamfan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"How common is left ventricular hypertrophy in HFpEF?","Question",{"text":63,"@type":64},"HFpEF affects 32 million patients worldwide, and LV hypertrophy or concentric remodelling is estimated to occur in more than 50% of the HFpEF population. LV hypertrophy is present in more than 20% of patients in contemporary randomized trials.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What mechanisms link cardiometabolic comorbidities to myocardial fibrosis in HFpEF?",{"text":68,"@type":64},"Hypertension, obesity, and diabetes increase haemodynamic load, cardiometabolic stress, and systemic inflammation, promoting structural remodelling. Additional mechanisms described include microvascular dysfunction, immune-cell infiltration, impaired energy metabolism, and interstitial/perivascular deposition of extracellular matrix proteins.",{"name":70,"@type":61,"acceptedAnswer":71},"How is HFpEF with LV hypertrophy diagnosed and assessed?",{"text":72,"@type":64},"Echocardiography uses criteria such as LV mass index thresholds, LVEF ≥ 50%, LA enlargement, and evidence of elevated filling pressures (e.g., E/e’ ratio and related measures). CMR assesses increased extracellular volume and late gadolinium enhancement, while pathology and plasma biomarkers support fibrotic remodelling and extracellular matrix regulation.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},433330,1790694747,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","European Heart Journal (2026) 47, 37–53 [https://doi.org/10.1093/eurheartj/ehaf524](https://doi.org/10.1093/eurheartj/ehaf524)  \nSTATE OF THE ART REVIEW  \nHeart failure and cardiomyopathies  \nLeft ventricular hypertrophy and myocardial fibrosis in heart failure with preserved ejection fraction: mechanisms and treatment  \nAlexander Peikert  1, Marianna Fontana  2, Scott D. Solomon  3, and Thomas Thum 4,5,*  \n1Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria; 2Division of Medicine, National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK; 3Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 4Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany; and 5Center for Translational Regenerative Medicine, Hannover Medical School, Carl-Neuberg-Str.  \n1, Hannover 30625, Germany  \nReceived 13 January 2025; revised 16 April 2025; accepted 7 July 2025; online publish-ahead-of-print 2 September 2025  \nGraphical Abstract  \nLeft ventricular hypertrophy and myocardial 􀀌brosis in HFpEF  \nEpidemiology  \n ~~ ~~ HFpEF a􀂔ects 32 million patients worldwide  \nLV hypertrophy or concentric remodelling are estimated to be present in >50%  \nof the HFpEF population  \nLV hypertrophy is present in >20% of HFpEF patients in contemporary randomized clinical trials  \nHigher prevalence of LV remodelling and hypertrophy observed with female sex, older age, and predisposing comorbidities  \nCharacteristics of HFpEF with LV hypertrophy Prognosis  \nSymptoms and/or signs of HF with LVEF ≥50% Evidence of structural and/or functional cardiac abnormalities consistent with the presence of LV diastolic dysfunction/ elevated LV 􀂉lling pressures Concentric LV remodelling or hypertrophy  \nLV hypertrophy in HFpEF is independently associated with a higher risk of HF hospitalization and CV death  \nClinical features Management of LV hypertrophy in HFpEF  \nMultimorbidity with high prevalence of cardiometabolic comorbidities, including hypertension, obesity, T2DM, or CAD  \nHFpEF GDMT including SGLT2 inhibitors, and ARNIs, MRAs, and ARBs in selected patients  \nPathophysiology Diagnosis establishment  \nThe presence of comorbidities including  \n hypertension, obesity, and diabetes leads  ECG: Increased QRS voltages  \nto increased haemodynamic load, cardiometabolic stress, and a systemic  \nproinflammatory state  \nComorbidity management according to guideline recommendations.  \nConsider 􀂉rst use of diseasemodifying therapeutics improving outcomes and LV hypertrophy  \nIdenti􀂉cation and disease-speci􀂉c treatment of ‘mimicking’ genetic, in􀂉ltrative, or storage disorders with hypertrophic phenotype  \nStructural remodelling with development of HFpEF with LV hypertrophy, ventricular sti􀂔ness, and diastolic dysfunction  \nCoronary microvascular dysfunction, myocardial immune cell in􀂉ltration,  \n tissue level proin􀂗ammatory and probiotic signalling,  NO bioavailability, and impaired cardiac energy metabolism  \nFibrotic remodelling with interstitial and perivascular deposition of extracellular matrix proteins  \nEchocardiography:  \n LV mass index ≥95 g/m2 in women and ≥115 g/m2 in men  \n LVEF ≥50%  \n LA enlargement  \n Presence of LV diastolic dysfunction/ elevated LV 􀂉lling pressures (E/e’ ratio at rest >9, PA systolic pressure tricuspid regurgitation velocity >35 mmHg)  \nCMR: Increased ECV and LGE  \nPathology: 􀂉brotic remodelling with interstitial and perivascular deposition of extracellular matrix proteins in the absence of signi􀂉cant myocyte loss  \nPlasma: biomarkers of extracellular matrix regulation  \nPathophysiology, phenotypical characteristics, epidemiology, and management strategies of HFpEF with left ventricular hypertrophy. Left ventricular mass index is determined based on LV mass and body surface area. ARB, angiotensin receptor blocker; ARNI, angiotensin receptor  \n* Corresponding aut","cbCaigEvrehPFub3","https://ap.wps.com/l/cbCaigEvrehPFub3","pdf",5979833,17,"English","# Epidemiology\n# Characteristics of HFpEF with LV hypertrophy\n# Prognosis\n# Clinical features\n# Management of LV hypertrophy in HFpEF\n# Pathophysiology\n## Diagnosis establishment","[{\"question\":\"How common is left ventricular hypertrophy in HFpEF?\",\"answer\":\"HFpEF affects 32 million patients worldwide, and LV hypertrophy or concentric remodelling is estimated to occur in more than 50% of the HFpEF population. LV hypertrophy is present in more than 20% of patients in contemporary randomized trials.\"},{\"question\":\"What mechanisms link cardiometabolic comorbidities to myocardial fibrosis in HFpEF?\",\"answer\":\"Hypertension, obesity, and diabetes increase haemodynamic load, cardiometabolic stress, and systemic inflammation, promoting structural remodelling. Additional mechanisms described include microvascular dysfunction, immune-cell infiltration, impaired energy metabolism, and interstitial/perivascular deposition of extracellular matrix proteins.\"},{\"question\":\"How is HFpEF with LV hypertrophy diagnosed and assessed?\",\"answer\":\"Echocardiography uses criteria such as LV mass index thresholds, LVEF ≥ 50%, LA enlargement, and evidence of elevated filling pressures (e.g., E/e’ ratio and related measures). CMR assesses increased extracellular volume and late gadolinium enhancement, while pathology and plasma biomarkers support fibrotic remodelling and extracellular matrix regulation.\"}]","Left ventricular hypertrophy and myocardial fibrosis in heart failure with preserved ejection fraction - mechanisms and treatment | PDF",1790663649,43]