Diffuse Right Ventricular Fibrosis in Diastolic Heart Failure: A Non-Invasive Multimodality Imaging Study

Approximately half of patients hospitalized for heart failure in the United States have diastolic heart failure (DHF). At Northwestern, the Cardiology Division sees approximately 1000 DHF patients per year and 80% of them have elevated pressure in the lung, otherwise known as pulmonary hypertension (PH-DHF). The one-year mortality for this disease is alarmingly high at 25-32% and many die from right heart failure. Unlike patients with systolic heart failure, there are no proven treatments for patients with PH-DHF. This is due to the incomplete understanding of its underlying pathophysiology and the mechanism by which the right ventricle fails. There is data to suggest that fibrosis plays a role in right ventricular dysfunction by causing it to stiffen, but current techniques to provide evidence for this are indirect and/or invasive. Our proposed study will use state-of-the-art two-dimensional (2D) echocardiography and cardiovascular MRI to non-invasively establish the existence of fibrosis in the right ventricle and correlate myocardial tissue abnormalities with adverse outcomes in PH-DHF patients. Given its unique and robust DHF Program and strength in echocardiography and cardiovascular MR research, Northwestern is uniquely suited for this endeavor. The ultimate goal is to provide mechanistic insight into this disease so that effective, targeted therapies can be developed.