{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:30:42Z","timestamp":1792801842283,"version":"4.5.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":100,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010447","name":"German Centre for Cardiovascular Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010447","name":"Deutsches Zentrum f\u00fcr Herz-Kreislaufforschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The pathophysiology of heart failure with preserved ejection fraction (HFpEF) includes pulmonary vascular remodelling and right ventricular (RV) involvement. We sought to investigate the significance of non-invasive cardiovascular magnetic resonance (CMR)-derived RV loading conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with exertional dyspnoea and diastolic dysfunction [E\/e\u2032 &amp;gt; 8, left ventricular ejection fraction (LVEF) &amp;gt;50%] underwent rest and exercise-stress echocardiography, right heart catheterization and CMR. HFpEF was defined by pulmonary capillary wedge pressure [rest \u226515 mmHg (overt) or stress \u226525 mmHg (masked)]; otherwise, patients were classified as non-cardiac dyspnoea (NCD). CMR-derived RV haemodynamic indices were defined as follows: afterload Ea = end-systolic pressure (ESP)\/stroke volume (SV), contractility Ees = ESP\/left ventricular end-systolic volume and RV\/pulmonary artery coupling as Ea\/Ees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HFpEF (n = 34; female 73.5%; median age 69 years) patients showed increased afterload and contractility at rest (Ea 1.20 vs. 0.85, P = 0.001, Ees 0.61 vs. 0.37, P &amp;lt; 0.001) and during exercise (Ea 2.48 vs. 1.53, Ees 1.00 vs. 0.74, P &amp;lt; 0.001) compared with NCD (n = 34; female 55.9%; median age 66 years). The relative increase of contractility from rest to stress was smallest in overt HFpEF (overt 1.40 vs. masked 1.86, P = 0.001) and highest in NCD (HFpEF 1.56 vs. NCD 1.97, P = 0.022). The out-of-proportion increase in afterload over contractility in HFpEF was reflected in a statistical trend towards increased Ea\/Ees from rest to stress in HFpEF (P = 0.078) while Ea\/Ees decreased in NCD (P = 0.002). Patients with resting Ea or Ees above the median showed lower exercise-induced increases in cardiac index (Ea: below: 2.8 vs. above: 2.2, P = 0.031; Ees: below: 2.9, above: 2.1, P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Resting RV afterload elevation in HFpEF results in a compensatory increase in contractility. Out-of-proportion increase of afterload paralleled by inadequate increase in contractility results in failure to increase the cardiac index in HFpEF, potentially associated with exertional functional failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.70007","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T03:04:43Z","timestamp":1762830283000},"page":"4391-4400","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exercise-Induced Out-Of-Proportion Increase in Afterload and Impaired Right Ventricular Contractile Reserve in HFpEF"],"prefix":"10.1093","volume":"12","author":[{"given":"Jan Sebastian","family":"Wolter","sequence":"first","affiliation":[{"name":"Department of Cardiology, Justus-Liebig-University Giessen, Kerckhoff-Clinic , Bad Nauheim ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Bad 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,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen D.","family":"Kriechbaum","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Justus-Liebig-University Giessen, Kerckhoff-Clinic , Bad Nauheim ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Bad Nauheim ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby","family":"Kutty","sequence":"additional","affiliation":[{"name":"Taussig Heart Center, Johns Hopkins Hospital , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes T.","family":"Kowallick","sequence":"additional","affiliation":[{"name":"FORUM Radiology , Rosdorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia M.","family":"Treiber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Justus-Liebig-University Giessen, Kerckhoff-Clinic , Bad Nauheim ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Bad Nauheim ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Rolf","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Justus-Liebig-University Giessen, Kerckhoff-Clinic , Bad Nauheim ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Bad Nauheim ,","place":["Germany"]},{"name":"Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, Justus-Liebig-University Giessen , Giessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Justus-Liebig-University Giessen, Kerckhoff-Clinic , Bad Nauheim 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