{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:59:16Z","timestamp":1788980356221,"version":"build-2803163510"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":1197,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T00:00:00Z","timestamp":1661472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP22uk1024007"],"award-info":[{"award-number":["JP22uk1024007"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007449","name":"Takeda Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007449","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP22uk1024007"],"award-info":[{"award-number":["JP22uk1024007"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007449","name":"Takeda Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007449","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Abnormal left ventricular diastolic response to preload stress can be an early marker of heart failure (HF). The aim of this study was to assess clinical course in patients with HF with preserved ejection fraction (HFpEF) who underwent preload stress echocardiography. In the subgroup analysis, we assessed the prognosis of patients with unstable signs during preload stress classified by treatment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We prospectively conducted preload stress echocardiographic studies between January 2006 and December 2013 in 211 patients with HFpEF. Fifty-eight patients had abnormal diastolic reserve during preload stress (unstable impaired relaxation: unstable IR). Of 58 patients with unstable IR, 19 patients were assigned to additional therapy by increased or additional therapy and 39 patients were assigned to standard therapy. Composite outcomes were prespecified as the primary endpoint of death and hospitalization for deteriorating HF. During a median period of 6.9 years, 19 patients (33%) reached the composite outcome. Unstable group with standard therapy had significantly shorter event-free survival than stable group. Patients with uptitration of therapy had longer event-free survival than those with standard therapy group after adjustment of laboratory data (hazard ratio, 0.20, 95% confidence interval, 0.05\u20130.90; P = 0.036); the 10 year event-free survival in patients with and without uptitration of therapy was 93% and 51%, respectively (P = 0.023).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with unstable sign had significantly shorter event-free survival than patients with stable sign. After additional therapy, the prognosis of patients with unstable signs improved. This technique may impact decision-making for improving their prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14127","type":"journal-article","created":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T05:10:26Z","timestamp":1661490626000},"page":"4020-4029","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Course and Decision-Making in Heart Failure by Preload Stress Echocardiography: A Preliminary Study"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4909-754X","authenticated-orcid":false,"given":"Kenya","family":"Kusunose","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotsugu","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences , Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihito","family":"Saijo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susumu","family":"Nishio","sequence":"additional","affiliation":[{"name":"Ultrasound Examination Center, Tokushima University Hospital , Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukina","family":"Hirata","sequence":"additional","affiliation":[{"name":"Ultrasound Examination Center, Tokushima University Hospital , Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Ise","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiju","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shusuke","family":"Yagi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Soeki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuzo","family":"Wakatsuki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Sata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tokushima University Hospital , 2-50-1 Kuramoto, Tokushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,26]]},"reference":[{"key":"2026012114134244300_ehf214127-bib-0001","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1016\/j.jacc.2020.11.012","article-title":"2021 ACC\/AHA key data elements and definitions for heart failure: a report of the American College of Cardiology\/American Heart Association task force on clinical data standards (Writing Committee to Develop Clinical Data Standards for Heart Failure)","volume":"77","author":"Bozkurt","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026012114134244300_ehf214127-bib-0002","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology 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