{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:48:39Z","timestamp":1753876119398,"version":"3.41.2"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,4,23]],"date-time":"2022-04-23T00:00:00Z","timestamp":1650672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Management of pulmonary hypertension (PH) in the setting of heart failure with preserved ejection fraction (HFpEF) can be challenging. Herein, we describe the case of a patient with HFpEF and combined pre- and post-capillary PH who showed striking improvement with sildenafil.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 74-year-old man presented with exertional dyspnea and near-syncope. He underwent a hemodynamic exercise study that showed evidence of HFpEF with pre- and post-capillary PH. Right ventricular endomyocardial biopsy showed interstitial fibrosis and mild hypertrophy, with no evidence of infiltrative or storage diseases. The patient was treated with sildenafil 20\u2005mg three times daily, which resulted in significant symptomatic and functional improvement in 12 years of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Phosphodiesterase 5 inhibitors are currently not approved by the United States Food and Drug Administration for treatment of PH in heart failure and are used off-label in patients with heart failure. This case illustrates the importance of unloading the right ventricle to improve cardiac output in patients with diastolic dysfunction and combined pre- and post-capillary PH. Although promising, future studies are needed to validate these findings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac179","type":"journal-article","created":{"date-parts":[[2022,4,23]],"date-time":"2022-04-23T06:01:42Z","timestamp":1650693702000},"source":"Crossref","is-referenced-by-count":0,"title":["Unloading the right to fill the left: vasodilation to treat hypotension: a case report"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6204-4557","authenticated-orcid":false,"given":"Fatima M.","family":"Ezzeddine","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3093-3744","authenticated-orcid":false,"given":"Melanie C.","family":"Bois","sequence":"additional","affiliation":[{"name":"Department of Pathology, Mayo Clinic College of Medicine , Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9375-0596","authenticated-orcid":false,"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic College of Medicine , 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,4,23]]},"reference":[{"key":"2022063018163008200_ytac179-B1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ccm.2020.11.002","article-title":"Pulmonary hypertension in left heart disease","volume":"42","author":"Reddy","year":"2021","journal-title":"Clin Chest Med"},{"key":"2022063018163008200_ytac179-B2","doi-asserted-by":"crossref","first-page":"e0247987","DOI":"10.1371\/journal.pone.0247987","article-title":"Combined pre- and post-capillary pulmonary hypertension: the clinical implications for patients with heart failure","volume":"16","author":"Ibe","year":"2021","journal-title":"PLoS One"},{"key":"2022063018163008200_ytac179-B3","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/eurheartj\/ehy809","article-title":"Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction","volume":"40","author":"Obokata","year":"2019","journal-title":"Eur Heart J"},{"key":"2022063018163008200_ytac179-B4","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1093\/eurheartj\/ehy331","article-title":"Exercise unmasks distinct pathophysiologic features in heart failure with preserved ejection fraction and pulmonary vascular disease","volume":"39","author":"Gorter","year":"2018","journal-title":"Eur Heart J"},{"key":"2022063018163008200_ytac179-B5","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.jchf.2019.03.021","article-title":"The role of the pericardium in heart failure: implications for pathophysiology and treatment","volume":"7","author":"Borlaug","year":"2019","journal-title":"JACC Heart Fail"},{"key":"2022063018163008200_ytac179-B6","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1001\/jama.2013.2024","article-title":"Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial","volume":"309","author":"Redfield","year":"2013","journal-title":"JAMA"},{"key":"2022063018163008200_ytac179-B7","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1161\/CIRCULATIONAHA.110.983866","article-title":"Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study","volume":"124","author":"Guazzi","year":"2011","journal-title":"Circulation"},{"key":"2022063018163008200_ytac179-B8","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1186\/s12872-020-01671-2","article-title":"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","volume":"20","author":"Belyavskiy","year":"2020","journal-title":"BMC Cardiovasc Disord"}],"container-title":["European Heart Journal - 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