Evidence map›Paper›PMID 25637629›Full record

ArticleCirculation2015

Myocardial stiffness in patients with heart failure and a preserved ejection fraction: contributions of collagen and titin.

Michael R Zile, Catalin F Baicu, John S Ikonomidis, Robert E Stroud, Paul J Nietert, Amy D Bradshaw, Rebecca Slater, Bradley M Palmer, Peter Van Buren, Markus Meyer and 4 more

Registry-linked trialAbstract readComparative Study
In one paragraph

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.

0numbers the graph read from it
0cells of the map it votes in
385citing papers in PubMed, 2 pooled it
38.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT04189029 unknown statusnot on this mapstarted 2019, after this paper: background citation

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)

Typeobservational_patient_registrySponsorAssistance Publique - Hôpitaux de ParisRan2019 to 2025Enrolled175ConditionsHeart Failure, Heart Failure With Preserved Ejection FractionArmsExtensive phenotyping
3 · Its place in the literature

Who cites it

385 citing papers in PubMed, 2 syntheses or guidelines pooled it, 651 citations in OpenAlex.

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  15. Microvascular dysfunction and heart failure with preserved ejection fraction.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
    Article
  16. 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 · 2026
    Review
  17. Review
  18. Mechanics of compression-driven morphogenesis.Development (Cambridge, England) · 2026
    Review
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325 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 1 country.

Michael R ZileFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.). zilem@musc.edu.
Catalin F BaicuFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
John S IkonomidisFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Robert E StroudFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Paul J NietertFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Amy D BradshawFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Rebecca SlaterFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Bradley M PalmerFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Peter Van BurenFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Markus MeyerFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Margaret M RedfieldFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
David A BullFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Henk L GranzierFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Martin M LeWinterFrom Division of Cardiology, Department of Medicine, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B., A.D.B.); Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (J.S.I., R.E.S.); Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC (P.J.N.); Department of Cellular and Molecular Medicine, University of Arizona, Tucson (R.S., H.L.G.); Cardiology Unit, Department of Medicine, University of Vermont, Burlington (B.M.P., P.V.B., M.M., M.M.L.W.); Department of Molecular Physiology and Biophysics, University of Vermont, Burlington (B.M.P., P.V.B., M.M.L.W.); Division of Cardiology, Mayo Clinic, Rochester, MN (M.M.R.); and Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City (D.A.B.).
Mayo Clinic in Arizona · USMedical University of South Carolina · USUniversity of Vermont · USUniversity of Arizona · US

Funding

South Carolina Clinical & Translational Research Institute (SCTR)UL1TR000062 · NCATS · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI BRADY, KATHLEEN T. · 2012 to 2014
$9.4M
Mayo Heart Failure Regional Clinical CenterU10HL110262 · NHLBI · MAYO CLINIC ROCHESTER · PI REDFIELD, MARGARET M · 2012 to 2018
$3.6M
Advanced Glycation End-Products in Human MyocardiumR01HL089944 · NHLBI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI LEWINTER, MARTIN M · 2008 to 2011
$2.6M
Heart Failure Clinical Trials NetworkU10HL110302 · NHLBI · EMORY UNIVERSITY · PI SMITH, ANDREW · 2012 to 2018
$2.5M
Myofilament-based mechanisms of diastolic dysfunction in HFpEFR01HL118524 · NHLBI · UNIVERSITY OF ARIZONA · PI GRANZIER, HENK L., LEWINTER, MARTIN M · 2014 to 2017
$2.5M
New England, New York and Quebec Regional Clinical CenterU10HL110342 · NHLBI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI HUGGINS, GORDON S, VANBUREN, PETER C · 2012 to 2018
$2.3M
Titin-Based Adaptations of Cardiac FunctionR01HL115988 · NHLBI · UNIVERSITY OF ARIZONA · PI GRANZIER, HENK L. · 2013 to 2019
$2.3M
Sarcolemmal Calcium Extrusion Defect in Patients with Diastolic DysfunctionR01HL122744 · NHLBI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI LUSTGARTEN, DANIEL L, MEYER, MARKUS · 2015 to 2019
$1.9M
Extracellular Matrix in Hypertensive Heart Disease & Transition to Heart FailureR01HL123478 · NHLBI · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI ZILE, MICHAEL R · 2015 to 2018
$1.5M
Extracellular Matrix in Hypertensive Heart Disease & Transition to Heart FailureR56HL123478 · NHLBI · MEDICAL UNIVERSITY OF SOUTH CAROLINA · PI ZILE, MICHAEL R · 2014 to 2014
$387k
Connexin Distribution in Physiological Versus Pathological Cardiac HypertrophyI01BX000487 · VA · RALPH H JOHNSON VA MEDICAL CENTER · PI ZILE, MICHAEL R · 2009 to 2013
–
AGE/RAGE Interaction in Patients with Pressure Overload-Induced Heart FailureI01CX000415 · VA · RALPH H JOHNSON VA MEDICAL CENTER · PI ZILE, MICHAEL R · 2011 to 2014
–
BLRD VA I01 BX000487CSRD VA I01 CX000415NCATS NIH HHS UL1 TR000062NCATS NIH HHS UL1TR000062NHLBI NIH HHS R01HL06288NHLBI NIH HHS R01 HL089944NHLBI NIH HHS R01HL089944NHLBI NIH HHS R01 HL115988NHLBI NIH HHS R01 HL118524NHLBI NIH HHS R01 HL122744NHLBI NIH HHS R01 HL123478NHLBI NIH HHS R56 HL123478NHLBI NIH HHS R56HL123478NHLBI NIH HHS U10 HL110262NHLBI NIH HHS U10 HL110302NHLBI NIH HHS U10 HL110342
6 · The paper itself

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.

Indexed as

AgedBiomarkersBiopsyCollagenComplianceConnectinDiabetes ComplicationsDiastoleElasticityFemaleHeart FailureHeart VentriclesHumansHypertensionInflammationMaleBiomarkersCollagenConnectinProtein IsoformsTTN protein, humancollagendiastoleheart failurehypertensionhypertrophy

Identifiers

PMID25637629
PMCPMC4390480
OpenAlexW2159549492

What OpenQuestion holds

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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.