ArticleCirculation2015
Myocardial stiffness in patients with heart failure and a preserved ejection fraction: contributions of collagen and titin.
Article in Circulation, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04189029 (Redefining the Phenotypic Spectrum of Heart Failure With Preserved Ejection Fraction), which is not on this map. Cited by 385 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Redefining the Phenotypic Spectrum of Heart Failure With Preserved Ejection Fraction (HFpEF) by Deep Phenotyping and Machine Learning Methods: The PACIFIC-PRESERVED Study (PhenomApping, ClassIFication, and Innovation for Cardiac Dysfunction - HF With PRESERVED LVEF Study)
Who cites it
385 citing papers in PubMed, 2 syntheses or guidelines pooled it, 651 citations in OpenAlex.
- Pooled it
- The utility of growth differentiation factor-15, galectin-3, and sST2 as biomarkers for the diagnosis of heart failure with preserved ejection fraction and compared to heart failure with reduced ejection fraction: a systematic review.Heart failure reviews · 2021Pooled it
- Cilostazol in patients with heart failure and preserved ejection fraction-The CLIP-HFpEF trial.ESC heart failure · 2025Trial
- Colchicine reduces inflammatory cytokines and improves symptoms in HFpEF: an observational pilot study.Frontiers in medicine · 2025Trial
- Dapagliflozin reduces systemic inflammation in patients with type 2 diabetes without known heart failure.Cardiovascular diabetology · 2024Trial
- Trial
- Pirfenidone in heart failure with preserved ejection fraction: a randomized phase 2 trial.Nature medicine · 2021Trial
- Diastolic contributors in cardiomyocytes of a cardiometabolic HFpEF-like mouse model.The Journal of general physiology · 2026Article
- Bidirectional metabolic-vascular feedback loops in heart failure: From myocardial energetics to multisystem cardiometabolic crosstalk.iScience · 2026Review
- Clonal Hematopoiesis and Inflammatory Pathways in Heart Failure with Preserved Ejection Fraction.Current heart failure reports · 2026Review
- Slow calcium removal contributes to impaired lusitropic response to β-adrenergic stimulation in HFpEF mice.The Journal of physiology · 2026Article
- Myofilament-level effects of aficamten increase diastolic chamber volumes and maintain cardiac output through preserved length-dependent force generation in healthy rat and canine myocardium.Basic research in cardiology · 2026Article
- Association Between Self-Reported Weekly Physical Activity Duration and Echocardiographic Cardiac Structure and Function in Adults Aged ≥ 45 Years: A Cross-Sectional Study.Journal of cardiovascular development and disease · 2026Article
- Cardiac, oxidative stress, and fibrosis-related biomarkers and new-onset heart failure: Systematic review and meta-analysis.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Microvascular dysfunction and heart failure with preserved ejection fraction.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Assessment of Exercise Intolerance and Evaluation for HFpEF: A Literature Review of Pathophysiology, Diagnosis, and Management.Pathophysiology : the official journal of the International Society for Pathophysiology · 2026Review
- Cardiac fibroblast diversity in HFpEF: states, niches, interorgan drivers and targets.Nature reviews. Cardiology · 2026Review
- Mechanics of compression-driven morphogenesis.Development (Cambridge, England) · 2026Review
- Targeting RUNX1 protects against diastolic dysfunction in a two-hit mouse model of heart failure with preserved ejection fraction.Cardiovascular research · 2026Article
- Reproducibility of 3.0 T single-frequency cardiac MR elastography for quantification of left ventricular myocardial stiffness.Radiology advances · 2026Article
325 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
14 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe purpose of this study was to determine whether patients with heart failure and a preserved ejection fraction (HFpEF) have an increase in passive myocardial stiffness and the extent to which discovered changes depend on changes in extracellular matrix fibrillar collagen and cardiomyocyte titin. METHODS AND
resultsSeventy patients undergoing coronary artery bypass grafting underwent an echocardiogram, plasma biomarker determination, and intraoperative left ventricular epicardial anterior wall biopsy. Patients were divided into 3 groups: referent control (n=17, no hypertension or diabetes mellitus), hypertension (HTN) without (-) HFpEF (n=31), and HTN with (+) HFpEF (n=22). One or more of the following studies were performed on the biopsies: passive stiffness measurements to determine total, collagen-dependent and titin-dependent stiffness (differential extraction assay), collagen assays (biochemistry or histology), or titin isoform and phosphorylation assays. In comparison with controls, patients with HTN(-)HFpEF had no change in left ventricular end-diastolic pressure, myocardial passive stiffness, collagen, or titin phosphorylation but had an increase in biomarkers of inflammation (C-reactive protein, soluble ST2, tissue inhibitor of metalloproteinase 1). In comparison with both control and HTN(-)HFpEF, patients with HTN(+)HFpEF had increased left ventricular end-diastolic pressure, left atrial volume, N-terminal propeptide of brain natriuretic peptide, total, collagen-dependent, and titin-dependent stiffness, insoluble collagen, increased titin phosphorylation on PEVK S11878(S26), reduced phosphorylation on N2B S4185(S469), and increased biomarkers of inflammation.
conclusionsHypertension in the absence of HFpEF did not alter passive myocardial stiffness. Patients with HTN(+)HFpEF had a significant increase in passive myocardial stiffness; collagen-dependent and titin-dependent stiffness were increased. These data suggest that the development of HFpEF depends on changes in both collagen and titin homeostasis.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.