email article A novel approach to heart failure with preserved ejection fraction (HFpEF) that takes a page from fibrotic lung disease appeared to pay off, with a reduction in myocardial fibrosis, the phase II PIROUETTE trial showed. The antifibrotic drug pirfenidone (Esbriet, approved for idiopathic pulmonary fibrosis) reduced myocardial extracellular volume by 1.21 percentage points more than placebo over 52 weeks (0.7% decline vs 0.5% increase, P=0.009). A treatment effect of that magnitude would be expected to translate to a 9% to 28% reduction in heart failure hospitalization or death, based on recent observational studies, reported Christopher Miller, MBChB, PhD, of the University of Manchester in England, at the virtual American College of Cardiology (ACC) meeting.