Trial reportCirculation2023
Challenging the Hemodynamic Hypothesis in Heart Failure With Preserved Ejection Fraction: Is Exercise Capacity Limited by Elevated Pulmonary Capillary Wedge Pressure?
Trial report in Circulation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT04068844 (Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction), which is not on this map. Cited by 38 papers, 1 of them a synthesis 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.
Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 52 citations in OpenAlex.
- The Impact of SGLT2 Inhibitors on Pulmonary Artery Pressures and Pulmonary Hemodynamics in Patients With Heart Failure: A Systematic Review.Cardiovascular therapeutics · 2025Pooled it
- Ventilatory limitation to exercise in patients with HFpEF and obesity: No room to breathe.Respiratory physiology & neurobiology · 2026Trial
- Crossover Trial of Exogenous Ketones on Cardiometabolic Endpoints in Heart Failure With Preserved Ejection Fraction.JACC. Heart failure · 2025Trial
- Dapagliflozin Enhances Arterial and Venous Compliance During Exercise in Heart Failure With Preserved Ejection Fraction: Insights From the CAMEO-DAPA Trial.Circulation · 2024Trial
- Oxygen cost of breathing and its association with dyspnea in older patients with heart failure with preserved ejection fraction and obesity.Journal of applied physiology (Bethesda, Md. : 1985) · 2026Article
- Sex-specific association between obesity and sympathetic nerve activity in HFpEF.American journal of physiology. Heart and circulatory physiology · 2026Article
- Exercise-Induced Pulmonary Hypertension: What Is New?Journal of cardiovascular development and disease · 2026Review
- Review
- Heart failure and preserved ejection fraction: pathophysiology, clinical assessment, and management of exercise intolerance.European heart journal · 2026Review
- Effects of Left Atrial Filling Pressure on Exercise Pulmonary Gas Exchange in HFpEF: Does the V-Wave Matter?Circulation. Heart failure · 2026Article
- Vasoreactivity Test With Nitrate-Hydralazine by Linking Gas Exchange and Hemodynamics in PH-HFpEF.Journal of cardiac failure - intersections · 2026Article
- Quantifying skeletal muscle energy metabolism during exercise in heart failure with preserved ejection fraction using in vivo 31P magnetic resonance spectroscopy.ESC heart failure · 2026Article
- Circumferential strain and strain rates of the descending aorta as novel measures of aortic stiffness and wall mechanics from standard cardiac MRI.Experimental physiology · 2026Article
- Determinants of exercise tolerance in HFpEF: role of the heart versus the periphery.Heart failure reviews · 2025Article
- Pressure applied: Mechanisms affecting heart-lung interactions and cardiac filling in patients with HFpEF during rest and exercise.Heart failure reviews · 2025Review
- Impaired exercise hemodynamic responses in patients with HFpEF without a sympathetic vasoconstrictor reserve.Autonomic neuroscience : basic & clinical · 2025Article
- Physiologic Phenotyping of Responses to Exercise and Activity in Heart Failure.Circulation research · 2025Review
- Chronotropic Incompetence and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.Journal of the American Heart Association · 2025Article
- Mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF).Heart failure reviews · 2025Review
- Maintained sympathetic reactivity but blunted pressor response to static handgrip exercise in heart failure with preserved ejection fraction.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2025Article
Corrections and comments
- Commented on by
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- Erratum issued
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundExercise intolerance is a defining characteristic of heart failure with preserved ejection fraction (HFpEF). A marked rise in pulmonary capillary wedge pressure (PCWP) during exertion is pathognomonic for HFpEF and is thought to be a key cause of exercise intolerance. If true, acutely lowering PCWP should improve exercise capacity. To test this hypothesis, we evaluated peak exercise capacity with and without nitroglycerin to acutely lower PCWP during exercise in patients with HFpEF.
methodsThirty patients with HFpEF (70±6 years of age; 63% female) underwent 2 bouts of upright, seated cycle exercise dosed with sublingual nitroglycerin or placebo control every 15 minutes in a single-blind, randomized, crossover design. PCWP (right heart catheterization), oxygen uptake (breath × breath gas exchange), and cardiac output (direct Fick) were assessed at rest, 20 Watts (W), and peak exercise during both placebo and nitroglycerin conditions.
resultsPCWP increased from 8±4 to 35±9 mm Hg from rest to peak exercise with placebo. With nitroglycerin, there was a graded decrease in PCWP compared with placebo at rest (-1±2 mm Hg), 20W (-5±5 mm Hg), and peak exercise (-7±6 mm Hg; drug × exercise stage
conclusionsSublingual nitroglycerin lowered PCWP during submaximal and maximal exercise. Despite reduction in PCWP, peak oxygen uptake was not changed. These results suggest that acute reductions in PCWP are insufficient to improve exercise capacity, and further argue that high PCWP during exercise is not by itself a limiting factor for exercise performance in patients with HFpEF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04068844.
Indexed as
Identifiers
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.