HFpEF: Why Earlier May Be Better | JACC Baran

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Shunichi Doi, MD (St. Marianna University School of Medicine) to discuss his JACC: Heart Failure study, Heart Failure Duration, Cardiac Remodeling, Dysfunction, and Hemodynamic Severity in HFpEF and HFmrEF: Insights From REDUCE LAP-HF II. In this prespecified subanalysis of the REDUCE LAP-HF II trial, 522 patients with HFpEF or HFmrEF were categorized by time since heart failure diagnosis (<1 year, 1–3 years, and >3 years). Longer disease duration was associated with progressive left and right ventricular dysfunction, biatrial remodeling, worsening resting and exercise hemodynamics, and higher rates of heart failure events. In contrast, patients with more recent diagnoses often had normal resting filling pressures with congestion evident only during exercise, suggesting that early HFpEF may be missed by conventional evaluation. The discussion explores whether HFpEF phenotypes represent distinct disease entities or sequential stages of progression, why exercise hemodynamic testing may be critical for early diagnosis, and how identifying HFpEF before advanced remodeling develops may open opportunities for earlier intervention.