Heart failure (HF) has traditionally been defined by symptoms of fluid accumulation and poor perfusion, but it is now recognized that specific HF classifications hold prognostic and therapeutic relevance. Specifically, HF with reduced ejection fraction is characterized by reduced left ventricular systolic pump function and dilation and HF with preserved ejection fraction is characterized primarily by abnormal left ventricular filling (diastolic failure) with relatively preserved left ventricular systolic function. These forms of HF are distributed equally among patients with HF and likely require distinctly different strategies to mitigate the morbidity, mortality, and medical resource utilization of this disease. In particular, HF is a significant medical issue within the US Department of Veterans Affairs (VA) hospital system and constitutes a major translational research priority for the VA. Because a common underpinning of both HF with reduced ejection fraction and HF with preserved ejection fraction seems to be changes in the structure and function of the myocardial extracellular matrix, a conference was convened sponsored by the VA, entitled, “Targeting Myocardial Fibrosis in Heart Failure” to explore the extracellular matrix as a potential therapeutic target and to propose specific research directions. The conference was conceptually framed around the hypothesis that although HF with reduced ejection fraction and HF with preserved ejection fraction clearly have distinct mechanisms, they may share modifiable pathways and biological mediators in common. Inflammation and extracellular matrix were identified as major converging themes. A summary of our discussion on unmet challenges and possible solutions to move the field forward, as well as recommendations for future research opportunities, are provided.

心力衰竭（HF）传统上被定义为积液和灌注不良的症状，但现在人们认识到特定的心力衰竭分类具有预后和治疗相关性。具体而言，射血分数降低的心力衰竭的特征是左心室收缩泵功能和扩张降低，而射血分数保留的心力衰竭的主要特征是左心室充盈异常（舒张衰竭），而左心室收缩功能相对保留。这些形式的心力衰竭在心力衰竭患者中平均分布，可能需要截然不同的策略来降低这种疾病的发病率、死亡率和医疗资源利用率。特别是，心力衰竭是美国退伍军人事务部 (VA) 医院系统内的一个重要医疗问题，也是 VA 的主要转化研究重点。由于射血分数降低的心力衰竭和射血分数保留的心力衰竭的共同基础似乎是心肌细胞外基质的结构和功能的变化，因此由 VA 主办了一次会议，题为“心力衰竭中的靶向心肌纤维化” ”探索细胞外基质作为潜在的治疗靶点并提出具体的研究方向。此次会议的概念框架是这样的：尽管射血分数降低的心力衰竭和射血分数保留的心力衰竭明显具有不同的机制，但它们可能共享可修改的途径和共同的生物介质。炎症和细胞外基质被认为是主要的共同主题。 提供了我们对未解决的挑战和推动该领域向前发展的可能解决方案的讨论摘要，以及对未来研究机会的建议。