Atrial fibrillation (AF) has traditionally been classified by episode duration, whereas rhythm control outcomes—via antiarrhythmic drugs or catheter ablation (CA)—have typically been evaluated using a binary approach, with any arrhythmic recurrence lasting over 30 s deemed a failure. Both definitions have notable limitations. Clinical classification often fails to accurately represent the actual time spent in arrhythmia, and AF recurrence following CA does not always correlate well with relevant clinical outcomes. This has driven increasing interest in the concept of AF burden which, although not consistently defined in literature, generally refers to the total percentage of time spent in arrhythmia during the monitoring period. Emerging evidence suggests that AF burden more accurately reflects the impact of CA on symptoms and serves as a valuable prognostic marker, particularly in specific patient subgroups. This review aims to summarise current knowledge on the impact and prognostic value of AF burden, highlighting unsolved issues, such as the absence of a standardised definition and the need for consensus on its use. Additionally, the review underscores the significance of monitoring strategies, highlighting the potential role that wearable devices and artificial intelligence could play in enhancing continuous monitoring in the near future.

Coronary microvascular dysfunction (CMD) is a key driver of ischemia and prognosis across several non-ischemic cardiomyopathies. This review summarizes the main tools for diagnosing microvascular dysfunction and available evidence on CMD incidence and the prognostic role in patients with cardiomyopathies. In dilated cardiomyopathy, CMD is associated with reduced myocardial blood flow, greater fibrosis, adverse remodeling, and worse outcomes. In hypertrophic cardiomyopathy, CMD is highly prevalent and multifactorial (arteriolar remodeling, reduced capillary density, extravascular compression, diastolic dysfunction, and/or left ventricular (LV) outflow obstruction), correlating with fibrosis, heart failure, and arrhythmias/sudden death. In Takotsubo syndrome, CMD appears acute and reversible, with microvascular spasms as a predominant mechanism and plausible pathophysiologic basis of the event. In arrhythmogenic right ventricular cardiomyopathy, preliminary data show a blunted hyperemic response and autonomic abnormalities that may impair microvascular vasodilation. In infiltrative and storage diseases (amyloidosis and Anderson–Fabry disease), CMD is often early, preceding hypertrophy/fibrosis, and contributes to symptoms, contractile dysfunction, and adverse outcomes; in sarcoidosis, microvascular inflammation reduces coronary flow reserve (CFR) and is associated with events. Targeted therapies remain limited; optimization of risk factors and drugs that modulate endothelial/metabolic function (statins, angiotensin converting enzyme (ACE) inhibitors, vasodilating β-blockers, calcium channel blockers, sodium glucose cotransporter 2 (SGLT2) inhibitors) yielded variable signals; device-based and nonpharmacologic strategies are under investigation. In conclusion, integrating microcirculatory assessment improves risk stratification and may furnish future therapeutic targets across cardiomyopathies.

BACKGROUND:In pulmonary arterial hypertension (PAH), echocardiographic ventriculoarterial coupling is traditionally assessed with the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). We aimed to validate the prognostic significance of the fractional area change (FAC)/PASP ratio in PAH. METHODS:This study included patients diagnosed with PAH between April 2001 and November 2023 enrolled in the multicentre FOCUS-PAH registry. Only patients with both FAC and PASP data available at PAH diagnosis were considered. The primary outcome of the study was to assess the predictive value of FAC/PASP for 1-year and 5-year all-cause mortality. RESULTS:347 patients were included. Mean age at PAH diagnosis was 56 ± 17 years; 144 (41.5%) patients were males. The median FAC/PASP ratio at diagnosis was 0.34%/mmHg [IQR 0.25 to 0.52%/mmHg]). 23 (6.6%) patients died during the first year of follow-up and 84 (24.2%) patients died within 5 years. At univariable Cox regression analyses, both low baseline FAC/PASP (i.e., lower than 0.37%/mmHg) and low TAPSE/PASP (i.e., lower than 0.18 mm/mmHg) significantly predicted 1-year all-cause mortality (HR 3.05 [95%CI 1.13-8.22], p-value 0.027, and HR 2.61 [95%CI 1.12-6.10], p-value 0.027, respectively); conversely, low FAC/PASP was associated with significantly higher all-cause mortality at 5 years (HR 1.69 [95%CI 1.08-2.65], p-value 0.023), whereas low TAPSE/PASP ratio was not (HR 1.21 [95%CI 0.77-1.91], p-value 0.405). In a clinical multivariable Cox regression model adjusting for age and World Health Organization functional class, a low FAC/PASP ratio was independently associated with a significantly increased risk of all-cause mortality, both at 1 year (HR 3.00 [95%CI 1.09-8.28], p-value = 0.034) and at 5 years (HR 1.72 [95%CI 1.09-2.72], p-value = 0.021). CONCLUSIONS:In this multicentre, observational registry on patients with incident PAH, low baseline FAC/PASP was associated with significantly higher 1-year and 5-year all-cause mortality.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual incretin agonists are now familiar drugs in obesity, diabetes, heart failure, and cardiovascular prevention. At the same time, a clinically relevant but molecule-specific human literature suggests that selected incretin-based therapies, particularly semaglutide for alcohol-related outcomes, may also modify alcohol use, tobacco use, and selected acute substance-related events. Alcohol currently has the strongest signal. Small randomized studies suggest semaglutide can reduce laboratory alcohol self-administration and craving, whereas an earlier exenatide trial was neutral overall but suggested benefit in participants with obesity. Large registry and EHR studies further associate GLP-1RA exposure with lower alcohol-related hospitalization, lower incident or recurrent alcohol use disorder, and lower alcohol-related event rates. Tobacco evidence is more limited but now includes a pilot smoking-cessation trial with exenatide and a target-trial emulation linking semaglutide with fewer tobacco use disorder-related healthcare encounters. Evidence beyond alcohol and tobacco, and tirzepatide specific evidence, remains preliminary, although lower rates of opioid overdose, alcohol intoxication, and cannabis use disorder have been reported in observational analyses. For cardiologists, the key question is not whether incretin therapies should be viewed as addiction drugs, but whether established cardiometabolic therapies may also modify cardiovascular relevant risk behaviors.

Aims Stereotactic arrhythmia radiotherapy (STAR) is an emerging non-invasive option for refractory ventricular tachycardia (VT); yet, the underlying myocardial effects in humans remain poorly understood. Within the STOPSTORM consortium, we developed the Bio-STAR framework for standardized ex vivo assessment of STAR-treated myocardium and here report its feasibility and initial findings in human samples.Methods and results Bio-STAR standardizes myocardial sampling into non-irradiated control (NFNI), minimally fibrotic irradiated, and fibrotic irradiated zones, guided by visual inspection, electroanatomical maps, and radiotherapy dose overlays. Recommended analyses span ex vivo MRI, histology, immunohistochemistry/-fluorescence, molecular panels, and live-cell assays. Application to two explanted non-ischaemic cardiomyopathy hearts (transplantation 3-5 months post-STAR) confirmed the protocol's applicability to end-stage remodelling. In exploratory analyses of irradiated regions, patient-specific patterns emerged, including stress marker upregulation, and altered NaV1.5, SERCA2a, and CaV1.2 when normalized to cardiomyocyte content. Functional analyses in a limited number of viable cardiomyocytes from the respective regions demonstrated heterogeneous excitability, supporting the feasibility of isolating live cells from STAR-treated regions in which Ca2+ signalling can be quantitatively assessed in future studies involving larger patient cohorts.Conclusion Bio-STAR provides a reproducible framework for multimodal analysis of STAR-treated myocardium, enabling harmonized cross-centre research. Early human data demonstrate that cardiomyocyte viability and isolatability are preserved across all assessed regions and that STAR-exposed areas may exhibit region-specific structural features, while functional data on Ca2+ handling remain exploratory and require validation in larger datasets. Broad adoption will be the key to delineating dose-time-substrate relationships and disentangling radiation effects from underlying cardiomyopathy.

BACKGROUND:Whether strut thickness influences clinical outcomes after percutaneous coronary intervention (PCI) for bifurcation lesions remains debated. AIMS:To compare the safety and efficacy of ultrathin (< 70 µm) drug-eluting stents (DES) with thicker DES in coronary bifurcations. METHODS:We pooled patient-level data from the ULTRA and BIFURCAT registries. Stents were classified as thick (≥ 100 µm), thin (70-100 µm), or ultrathin (< 70 µm). The primary endpoint was target-lesion revascularization (TLR). Inverse probability of treatment weighting (IPTW) balanced baseline characteristics overall and within procedural subgroups (provisional vs. planned two-stent strategy). RESULTS:Among 6753 patients (median follow-up 800 days, IQR 400-900), 514 (8%) received thick, 5139 (76%) thin, and 1100 (16%) ultrathin stents. Crude TLR rates were 3.3%, 2.8%, and 1.1%, respectively (p = 0.001). After IPTW adjustment, ultrathin DES significantly reduced TLR compared with thick DES (HR 0.38, 95% CI = 0.16-0.89, p = 0.03) and with thin DES (HR 0.41, 95% CI 0.21-0.81, p = 0.01). In provisional-stenting cases, TLR risk did not differ across groups (HR: 0.53 vs. thick, p = 0.27; HR: 0.49 vs. thin, p = 0.07). Conversely, in planned two-stent procedures ultrathin DES resulted associated with TLR reduction versus thick DES (HR: 0.21, 95% CI 0.04-0.93, p = 0.04), with a nonsignificant trend for thin DES (HR: 0.31, p = 0.07). CONCLUSIONS:In contemporary bifurcation PCI, ultrathin DES are associated with a clinically and statistically significant reduction in repeat revascularization compared with thicker-strut platforms, a benefit driven predominantly by lesions treated with an upfront two-stent approach.

Background. Although international guidelines recommend increasingly lower thresholds for low-density lipoprotein cholesterol (LDL-C), everyday clinical experience shows that many patients fail to reach these targets, exposing themselves to a significant residual cardiovascular risk. Clear Pathway-a patient-centered approach to dyslipidemia-was developed to bridge this gap by promoting an integrated use of oral lipid-lowering therapies. Methods. In the Clear Pathway project, a panel of hospital cardiologists applied a mini-Delphi methodology in two rounds to evaluate 20 statements related to lipid-lowering therapy, divided into three thematic areas: oral combination and fixed-dose strategies; use of LDL-C target distance as a guide to treatment decisions; and personalization based on patient's clinical profile. Each statement was rated on a 1-5 Likert scale and approved if the average score was >= 4.0. Statements not approved in the first round were reformulated and resubmitted. Results. In the first round, 17 out of 20 statements met the consensus threshold and were approved without any modification. The three statements not approved (early intensification in post-acute coronary syndrome patients with LDL-C <140 mg/dl, use of bempedoic acid in patients undergoing elective angioplasty, and in those one with stroke) were reformulated and resubmitted during a second round, where they also reached the approval threshold. Conclusions. The Clear Pathway recommendations outline a model for dyslipidemia management based on integrated oral therapies, with a key role for bempedoic acid. Adopting these guidelines is expected to improve adherence, optimize achievement of LDL-C targets, and reduce the incidence of cardiovascular events in routine clinical practice.

Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) coexist in 40-60% of cases and mutually reinforce each other through adverse electrical, cellular, and functional remodelling. There is considerable overlap in signs and symptoms, and diagnosis may be challenging due to nonspecific clinical presentations and chronic course. AF is clearly linked with worsening morbidity and mortality in HFpEF with higher rates of HF hospitalizations, HF progression, stroke, systemic embolism, and all-cause death. Optimal management of HFpEF-AF patients requires aggressive treatment of comorbidities and risk factor modification. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated consistent benefit with respect to HF hospitalizations, symptoms and exercise haemodynamics, and potential to reduce AF burden. Gastric inhibitory polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) agonists, mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and statins may provide benefit in selected phenotypes, though evidence remains heterogeneous. A rhythm control strategy in the early clinical course of HFpEF might be a reasonable strategy to improve symptoms and delay both AF and HFpEF disease progression. Catheter ablation appears to improve exercise haemodynamics and quality of life, and observational data suggest it may reduce mortality and HF hospitalization, though current evidence is inconsistent and not yet definitive. Emerging device-based and molecular therapies could represent promising avenues for future research. Overall, early detection of AF, comprehensive risk-factor modification, and tailored rhythm-control strategies are central to improving outcomes in the HFpEF-AF overlap syndrome.

AIMS:Long-term arrhythmic risk after myocarditis remains uncertain, and optimal management is debated. We aimed to assess the incidence and predictors of major arrhythmic events (MAEs) after myocarditis. METHODS AND RESULTS:We conducted a systematic literature review and meta-analysis including 19 observational studies on myocarditis and MAEs during follow-up. Major arrhythmic events were defined as a composite of sudden cardiac death (SCD), ventricular fibrillation (VF), aborted cardiac arrest (ACA), sustained ventricular tachycardia (sVT), and appropriate implantable cardioverter defibrillator (ICD) or wearable-cardioverter defibrillator (WCD) intervention. The primary outcome was the incidence of MAEs after discharge; secondary outcomes included occurrence of each component of MAEs and the composite of all-cause mortality or heart transplantation (HTx). Three thousand nine hundred and fifty-four patients (71% male, 67% acute, 88% complicated myocarditis) were included. At presentation, 15% had high-grade atrioventricular block (AVB), 31% heart failure, 38% MAEs. At a median follow-up of 24 months (interquartile range 19-57), 28% suffered MAEs, with a median time of presentation of 12 months. The incidence of sVT, ACA/VF, appropriate ICD/WCD intervention, and SCD were 22%, 6%, 20%, and 1%, respectively. The combined rate of all-cause mortality/HTx was 11%. At meta-regression analysis, high-grade AVB, MAEs at presentation, and fulminant myocarditis were associated with higher risk of MAEs during follow-up, while male gender resulted as a protective factor. CONCLUSION:The incidence of MAEs after a complicated acute myocarditis can be high over time. Further prospective studies are needed to better stratify high-risk patients, identify those with an underlying arrhythmogenic cardiomyopathy, and guide antiarrhythmic strategies.

BACKGROUND:The Venous Excess Ultrasound (VExUS) score is increasingly used to assess systemic venous congestion, yet direct validation against invasively measured right atrial pressure (RAP) in pulmonary hypertension (PH) remains limited. RESEARCH QUESTION:How accurate is the VExUS score to predict RAP in patients with established or suspected PH? METHODS:We conducted a multicenter observational study across 7 Italian reference centers including patients referred for PH and undergoing a VExUS assessment and right heart catheterization within 1 hour. A VExUS score was calculated with a 0 to 3 grading based on inferior vena cava (IVC) diameter and collapsibility, and Doppler assessment of hepatic, portal, and intrarenal venous flow patterns. The diagnostic performance of VExUS for identifying elevated RAP thresholds was compared with echocardiographic estimates based on IVC diameter and inspiratory collapse and RA surface areas using a multivariable analysis followed by receiver operator curves (ROC) calculations. Subgroup analyses were performed across pulmonary hemodynamic phenotypes (normal hemodynamics vs pre- vs postcapillary PH). RESULTS:The study included 145 patients with pre-capillary PH, most of whom with pulmonary arterial hypertension (PAH), 21 with post-capillary PH, and 21 with no PH. The VExUS score showed a strong graded association with RAP, with mean RAP increasing across VExUS grades (0: 3.9 mmHg; 1: 8.4 mmHg; 2: 13.5 mmHg; 3: 15.8 mmHg; p<0.001). The VExUS score demonstrated excellent discrimination for elevated RAP >12 mmHg (AUC 0.97, 95% CI 0.94-0.99), with higher diagnostic performance than isolated echocardiographic markers and performance comparable to echocardiographic RAP estimation. These findings were consistent across hemodynamic phenotypes.

BACKGROUND:Actionable quality gaps persist in low-density lipoprotein cholesterol (LDL-C) management after acute myocardial infarction (AMI). We aimed to quantify diagnostic and therapeutic inertia in LDL-C management after discharge in a real-world AMI population with verified and quantified consecutive inclusion. METHODS:We conducted a quality improvement audit of patients discharged alive with a primary diagnosis of AMI. Consecutiveness was quantified using the consecutive index (e.g., the ratio of included patients with available 6-month follow-up information to the total AMI discharges). Diagnostic inertia was defined as no evidence of LDL-C measurement post-discharge. Therapeutic inertia was defined as LDL-C ≥ 55 mg/dL in the absence of optimal lipid-lowering therapy among patients with at least one post-discharge LDL-C measurement. A multivariable model was developed to identify risk-adjusted probability of LDL-C target achievement at follow-up. RESULTS:Among 3490 AMI patients, 3130 had at least a follow-up assessment after discharge. At six months, 2603 patients had available information on vital status, follow-up assessment, and post-discharge LDL-C assessment status (consecutive index: 74.6% [95% CI: 73.1-76.0%]). Diagnostic inertia occurred in 19.3% (95% CI: 17.8-20.9%) and therapeutic inertia in 38.1% (95% CI: 35.7-40.6%). In a multivariable model, the explained variance was modest (R2=14.4%; 95% CI: 12.0-18.2%). CONCLUSIONS:In a contemporary cohort including approximately 75% of patients surviving hospitalization for AMI, one in five patients did not undergo LDL-C testing during follow-up and two in five did not receive adequate lipid-lowering therapy despite failing to reach guideline-recommended targets. These findings highlight a substantial opportunity for structured quality improvement initiatives targeting LDL-C management after AMI.

Background: Genetic testing in hypertrophic cardiomyopathy (HCM) yields variable positivity rates. Identifying clinical predictors of positive genetic tests could improve pre-test counseling and refine expectations about diagnostic yield. Methods: We analyzed consecutive genotyped HCM probands from a contemporary multicenter cohort across four Italian tertiary centers. Genotype positivity was defined as the presence of >= 1 pathogenic or likely pathogenic variant (ACMG classes 4-5). Multivariable logistic regression identified predictors of genotype positivity. Sensitivity analyses assessed the incremental value of left atrial volume index (LAVI) >= 34 mL/m(2) and the mode of first clinical presentation. Results: Among 274 genotyped probands (median age at diagnosis 54 years; 62% male), 86 (31%) were genotype-positive (38% MYBPC3, 29% MYH7). Age at diagnosis <40 years (OR 2.38, 95%CI 1.26-4.51, p = 0.008), family history of sudden cardiac death/major ventricular arrhythmias (OR 2.34, 95%CI 1.16-4.84, p = 0.019) and family history of non-ischemic cardiomyopathy (OR 1.92, 95%CI 1.04-3.54, p = 0.038), were independently associated with genotype positivity whereas arterial hypertension was inversely associated (OR 0.42, 95%CI 0.23-0.77). Maximal left ventricular wall thickness > 20 mm and gender were not predictive of genotype positivity. Inclusion of LAVI modestly improved the model performance (AUC 0.769, p = 0.016, Delta AUC +0.024; DeLong p = 0.016) but without leading to meaningful patient reclassification. Conclusions: Genotype positivity in HCM links to earlier onset and family history; traditional severity markers and initial presentation may not independently suggest genetic causality. These findings may help shape a personalized approach to genetic counseling in HCM.

BACKGROUND:Although international guidelines recommend increasingly lower thresholds for low-density lipoprotein cholesterol (LDL-C), everyday clinical experience shows that many patients fail to reach these targets, exposing themselves to a significant residual cardiovascular risk. Clear Pathway - a patient-centered approach to dyslipidemia - was developed to bridge this gap by promoting an integrated use of oral lipid-lowering therapies. METHODS:In the Clear Pathway project, a panel of hospital cardiologists applied a mini-Delphi methodology in two rounds to evaluate 20 statements related to lipid-lowering therapy, divided into three thematic areas: oral combination and fixed-dose strategies; use of LDL-C target distance as a guide to treatment decisions; and personalization based on patient's clinical profile. Each statement was rated on a 1-5 Likert scale and approved if the average score was ≥4.0. Statements not approved in the first round were reformulated and resubmitted. RESULTS:In the first round, 17 out of 20 statements met the consensus threshold and were approved without any modification. The three statements not approved (early intensification in post-acute coronary syndrome patients with LDL-C <140 mg/dl, use of bempedoic acid in patients undergoing elective angioplasty, and in those one with stroke) were reformulated and resubmitted during a second round, where they also reached the approval threshold. CONCLUSIONS:The Clear Pathway recommendations outline a model for dyslipidemia management based on integrated oral therapies, with a key role for bempedoic acid. Adopting these guidelines is expected to improve adherence, optimize achievement of LDL-C targets, and reduce the incidence of cardiovascular events in routine clinical practice.

Aims Percutaneous stellate ganglion block (PSGB) is a promising treatment for refractory electrical storm (ES). However, there is a lack of solid indications regarding the optimal pharmacological regimens and combination of local anaesthetics (LAs). This study, from the multicentre STAR registry, aimed to evaluate the impact of single vs. dual LA regimen on the efficacy and safety of PSGB. Methods and results We analysed 422 PSGB procedures from 298 patients (30% single LA, 70% dual LAs). Both regimens significantly reduced the number of treated ventricular arrhythmias (VAs) in the 12 h post-PSGB. Crucially, the combination of two LAs-typically pairing a fast-acting with a long-acting agent-resulted in a significantly higher rate of complete VA suppression at 1 h (85% vs. 70%, P < 0.01) and 3 h (78% vs. 67%, P = 0.02) compared with the single LA regimen. This superior early efficacy was confirmed after propensity score matching and multivariable analysis. The total complication rate, driven by minor ones, was higher with two LAs (8% vs. 2%, P = 0.02), but this association was no longer significant after adjusting for the procedural approach (lateral vs. anterior). Conclusion The combination of two local anaesthetics for PSGB is significantly associated with a greater likelihood of early and complete ventricular arrhythmia suppression in patients with electrical storm. Despite the need for randomized ad hoc trials, the dual-LA regimen represents an optimization strategy for PSGB, offering enhanced efficacy without an increased risk of major complications.

Despite advances in guideline-directed medical therapy (GDMT), heart failure with reduced ejection fraction (HFrEF) remains a progressive condition with high morbidity and mortality. Vericiguat, a soluble guanylate cyclase (sGC) stimulator, represents a novel therapeutic class that augments the nitric oxide–sGC–cyclic guanosine monophosphate (cGMP) pathway, which is impaired in HFrEF. The VICTORIA trial demonstrated that vericiguat significantly reduced the composite endpoint of cardiovascular death or heart failure hospitalization (HFH) in high-risk patients following a worsening event. Recent data from the VICTOR trial and subsequent pooled analyses suggest broader applicability, indicating that vericiguat may signal a potential mortality benefit in selected stable, ambulatory HFrEF patients with elevated natriuretic peptides but without recent hospitalization. The safety profile is favorable, with hypotension being the most common adverse event. Overall, vericiguat offers a valuable therapeutic option for a wide spectrum of HFrEF patients. Moreover, the ability of vericiguat to improve outcomes in both post-worsening and selected high-risk stable populations suggests this sGC stimulator may serve as a critical fifth component of GDMT, offering a new avenue for a personalized approach to HFrEF treatment. This review synthesizes key clinical evidence to elucidate the role of vericiguat in modern HFrEF management.

AIMS:The pathogenesis of pulmonary hypertension associated with heart failure (PH-HF) is partially understood. To advance knowledge in this regard, the investigator-initiated, public-funded, prospective, translational stuDy to dISseCt remOdeling of capillaries and Veins in pulmonary hypErtension associated with heaRt failure (DISCOVER PH-HF) will assess biomarkers of PH-HF in pulmonary capillary and venous (PCV) and peripheral venous blood taken during right heart catheterization (RHC). This report presents the design of DISCOVER PH-HF and the baseline characteristics of the included patients. METHODS:DISCOVER PH-HF enrolled heart failure patients scheduled for transcatheter edge-to-edge repair (TEER) of severe mitral regurgitation. PCV and peripheral venous whole blood was collected during RHC within 48 h before mitral regurgitation (MR)-TEER, and processed into plasma/serum aliquots and peripheral blood mononuclear cell (PBMC) pellets. Then, the samples were centralized to a core biobank. Follow-up entails visits at 90 ± 10 and 180 ± 10 days and - optionally - a second RHC with collection of PCV and peripheral venous blood within 30 days from the second follow-up evaluation. A proteomic analysis of part of the PCV and peripheral plasma is already planned. RESULTS:Seven patients without pulmonary hypertension at RHC, 12 patients with isolated postcapillary pulmonary hypertension, and 18 patients with combined postcapillary and precapillary pulmonary hypertension were recruited, leading to a total of 148 PCV and 148 peripheral plasma aliquots, 111 PCV and 111 peripheral serum aliquots, and 37 PBMC pellets. CONCLUSION:DISCOVER PH-HF has generated a limited-size, but unique biobank of RHC-derived PCV and peripheral venous blood samples and PBMCs, linked to clinical and hemodynamic phenotyping, which will allow the exploration of biomarkers of PH-HF and its subtypes.