Evidence map›Paper›PMID 41615840›Full record

Trial reportRespiratory physiology & neurobiology2026

Ventilatory limitation to exercise in patients with HFpEF and obesity: No room to breathe.

Tony G Babb, Bryce N Balmain, Andrew R Tomlinson, Linda S Hynan, Benjamin D Levine, James P MacNamara, Satyam Sarma

Registry-linked trialAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Respiratory physiology & neurobiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. 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 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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.

NCT04068844 nacompletednot on this map

Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction

TypeinterventionalSponsorUniversity of Texas Southwestern Medical CenterRan2019 to 2026Enrolled93ConditionsHeart Failure, DiastolicArmsExercise training
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Tony G BabbInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: DrTonyBabb@TexasHealth.org.
Bryce N BalmainInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Andrew R TomlinsonInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Linda S HynanPeter O'Donnell Jr. School of Public Health and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Benjamin D LevineInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
James P MacNamaraInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Satyam SarmaInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Funding

Targeting skeletal muscle to improve exercise capacity in heart failure with preserved ejection fraction.P01HL137630 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI FU, QI · 2019 to 2023
$11.4M
UT Southwestern NORCP30DK127984 · NIDDK · UT SOUTHWESTERN MEDICAL CENTER · PI Jeffrey M Zigman · 2022 to 2026
$7.4M
Targeting breathing limitations to improve functional outcomes in HFpEFR00HL164957 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI Bryce Balmain · 2025 to 2026
$498k
Targeting breathing limitations to improve functional outcomes in HFpEFK99HL164957 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI BALMAIN, BRYCE · 2023 to 2024
$270k
NHLBI NIH HHS K99 HL164957NHLBI NIH HHS P01 HL137630NHLBI NIH HHS R00 HL164957NIDDK NIH HHS P30 DK127984
6 · The paper itself

Abstract

backgroundLowering pulmonary capillary wedge pressure (PCWP) by sublingual nitroglycerin (NTG) fails to increase exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF). These findings beg the question as to the origin of exercise limitation. Our objective was to determine whether exercise tolerance could be ventilatory limited in older patients with HFpEF and obesity.

methodsPatients with HFpEF and obesity (n = 42) underwent pulmonary artery and radial artery catheterizations. Cardiorespiratory responses, breathing mechanics, and arterial blood gases were measured at rest, 20 W, and at peak exercise before and after NTG.

resultsAt rest, there was a drop in cardiac output and PaO

conclusionsWe conclude that mechanical ventilatory constraints coupled with increased ventilatory inefficiency impose a ventilatory limitation to exercise in patients with HFpEF and obesity. CLINICAL TRIAL INFORMATION: Clinical Trials number: NCT04068844.

Indexed as

ExerciseExercise ToleranceHeart FailureObesityRespiratory MechanicsAgedFemaleHumansMaleMiddle AgedNitroglycerinStroke VolumeVasodilator AgentsNitroglycerinVasodilator AgentsBreathing mechanicsExercise intoleranceVentilatory demandVentilatory inefficiencyVentilatory limitations to exercise

Identifiers

PMID41615840
PMCPMC13156900

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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.