ArticleEuropean heart journal2018
Exercise unmasks distinct pathophysiologic features in heart failure with preserved ejection fraction and pulmonary vascular disease.
Article in European heart journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 107 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
107 citing papers in PubMed, 3 syntheses or guidelines pooled it, 212 citations in OpenAlex.
- The effect of exercise training and physiotherapy on left and right heart function in heart failure with preserved ejection fraction: a systematic literature review.Heart failure reviews · 2023Pooled it
- Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta-analysis.ESC heart failure · 2022Pooled it
- Diagnostic, prognostic and differential-diagnostic relevance of pulmonary haemodynamic parameters during exercise: a systematic review.The European respiratory journal · 2022Pooled it
- Latent Pulmonary Vascular Disease May Alter the Response to Therapeutic Atrial Shunt Device in Heart Failure.Circulation · 2022Trial
- Phosphodiesterase 5 inhibitor sildenafil in patients with heart failure with preserved ejection fraction and combined pre- and postcapillary pulmonary hypertension: a randomized open-label pilot study.BMC cardiovascular disorders · 2020Trial
- The haemodynamic basis of lung congestion during exercise in heart failure with preserved ejection fraction.European heart journal · 2019Trial
- The neurohormonal basis of pulmonary hypertension in heart failure with preserved ejection fraction.European heart journal · 2019Trial
- The β-Adrenergic Agonist Albuterol Improves Pulmonary Vascular Reserve in Heart Failure With Preserved Ejection Fraction.Circulation research · 2019Trial
- Exercise-Induced Alterations in Lung Water Density in Heart Failure Using Single-Breath-Hold 3D Ultrashort Echo Time MRI.Journal of magnetic resonance imaging : JMRI · 2026Article
- Exercise-Induced Pulmonary Hypertension: What Is New?Journal of cardiovascular development and disease · 2026Review
- Echocardiographic Phenomapping in HFpEF: From Imaging Biomarkers to Precision Cardiovascular Medicine.Echocardiography (Mount Kisco, N.Y.) · 2026Review
- Association of daily physical activity with pulmonary artery pressure in HFpEF and HFmrEF NYHA class III patients: a pilot trial-feasibility and first results.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Tricuspid Regurgitation Across the Spectrum of Heart Failure With Preserved Ejection Fraction.Journal of the American College of Cardiology · 2025Article
- Evaluation of pulmonary hypertension in heart failure with preserved ejection fraction.Heart failure reviews · 2025Review
- Atrial Fibrillation (AF) and Heart Failure With Preserved Ejection Fraction (HFpEF): Advances and Challenges.Journal of cardiovascular electrophysiology · 2025Review
- Vascular (dys)function in the failing heart.Nature reviews. Cardiology · 2025Review
- Advancing Cardiovascular Risk Stratification and Functional Assessment: A Narrative Review of CPET and ESE Applications.Healthcare (Basel, Switzerland) · 2025Review
- Physiologic Phenotyping of Responses to Exercise and Activity in Heart Failure.Circulation research · 2025Review
- Mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF).Heart failure reviews · 2025Review
- Non-Invasive Hemodynamic Assessment of Heart Failure With Preserved Ejection Fraction.Korean circulation journal · 2025Review
47 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
Abstract
Aims: Pulmonary hypertension (PH) and pulmonary vascular disease (PVD) are common and associated with adverse outcomes in heart failure with preserved ejection fraction (HFpEF). Little is known about the impact of PVD on the pathophysiology of exercise intolerance. Methods and results: Heart failure with preserved ejection fraction patients (n = 161) with elevated pulmonary capillary wedge pressure (≥15 mmHg) at rest were classified into three groups: non-PH-HFpEF (n = 21); PH but no PVD (isolated post-capillary PH, IpcPH; n = 95); and PH with PVD (combined post- and pre-capillary PH, CpcPH; n = 45). At rest, CpcPH-HFpEF patients had more right ventricular (RV) dysfunction and lower pulmonary arterial (PA) compliance compared to all other groups. While right atrial pressure (RAP) and left ventricular transmural pressure (LVTMP) were similar in HFpEF with and without PH or PVD at rest, CpcPH-HFpEF patients demonstrated greater increase in RAP, enhanced ventricular interdependence, and paradoxical reduction in LVTMP during exercise, differing from all other groups (P < 0.05). Lower PA compliance was correlated with greater increase in RAP with exercise. During exercise, CpcPH-HFpEF patients displayed an inability to enhance cardiac output, reduction in forward stroke volume, and blunted augmentation in RV systolic performance, changes that were coupled with marked limitation in aerobic capacity. Conclusion: Heart failure with preserved ejection fraction patients with PVD demonstrate unique haemodynamic limitations during exercise that constrain aerobic capacity, including impaired recruitment of LV preload due to excessive right heart congestion and blunted RV systolic reserve. Interventions targeted to this distinct pathophysiology require testing in patients with HFpEF and PVD.
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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.