{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:31:19Z","timestamp":1792801879368,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":154,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010447","name":"German Center for Cardiovascular Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Right ventricular (RV) dysfunction has been associated with worse prognosis in patients with diastolic dysfunction, highlighting the importance of early detection. Main pulmonary artery (MPA) compliance may indicate adverse biventricular coupling prior to emerging RV function.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Sixty-eight patients with suspected diastolic dysfunction (New York Heart Association \u2265 II, LV EF \u2265 50%, E\/e\u2032 \u2265 8) were prospectively recruited and underwent rest and stress right heart catheterization, echocardiography, and cardiovascular magnetic resonance imaging (CMR) within 24\u2005h. Maximum (Amax) and minimum (Amin) MPA vessel area and stroke volume (RVSV) were obtained from CMR real-time phase-contrast images at rest and during exercise stress. Compliance was calculated as pulsatility MPAPuls=(Amax\u2212AminAmin)\u00d7100 and capacitance MPACap=MPAPulsRVSV. Patients had systematic follow-up after 48 months. Occurrence of cardiovascular events was defined as the primary endpoint. A total of 63 patients [66 \u00b1 9 years, 39 (61.9%) female] were eligible for final analyses. MPAPuls and MPACap were lower during exercise stress compared with rest (20% vs. 17.5%, P = 0.034 and 0.26%\/mL vs. 0.20%\/mL, P = 0.001). Subgroups with and without heart failure with preserved ejection fraction (HFpEF) had similar MPA compliance at rest, however, HFpEF patients had a steeper decrease of compliance during exercise stress (MPAPuls 13% vs. 20%; P &amp;lt; 0.001 MPACap 0.16%\/mL vs. 0.25%\/mL, P = 0.018). Decreasing MPAPuls and MPACap during exercise stress correlated with markers of diastolic dysfunction including pulmonary capillary wedge pressure, E\/e\u2032, and HFA-PEFF score. Patients with decreased MPAPuls (HR 6.0; P = 0.016) and MPACap (HR 11.3; P = 0.015) had worse outcomes independent from conventional markers of diastolic dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with suspected diastolic dysfunction and preserved RV function, exercise-stress testing unmasked decreasing CMR-derived MPA compliance, associated with LV diastolic dysfunction and indicated higher risk for cardiovascular events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyaf077","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T18:22:44Z","timestamp":1749061364000},"source":"Crossref","is-referenced-by-count":1,"title":["Pathophysiological and prognostic relevance of exercise CMR-derived pulmonary artery compliance in patients with suspected diastolic dysfunction and normal right ventricular function"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5589-8792","authenticated-orcid":false,"given":"Alexander","family":"Schulz","sequence":"first","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]},{"name":"Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School , 330 Brookline Ave, Boston, MA 02215 ,","place":["USA"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Lower Saxony , Niedersachsen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Kuttenkeuler","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f6ren J","family":"Backhaus","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main , Bad Nauheim ,","place":["Germany"]},{"name":"Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic , 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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0505-2582","authenticated-orcid":false,"given":"Torben","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Lower Saxony , Niedersachsen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Otto","sequence":"additional","affiliation":[{"name":"Fakult\u00e4t f\u00fcr Mathematik und Informatik, Georg-August Universit\u00e4t G\u00f6ttingen , Bunsenstra\u00dfe 3-5, G\u00f6ttingen 37073 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Gronwald","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Lower Saxony , Niedersachsen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Evertz","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Lower Saxony , Niedersachsen ,","place":["Germany"]}],"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":"Gerd","family":"Hasenfu\u00df","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Lower Saxony , Niedersachsen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen, Georg-August University , Robert-Koch-Str. 40, G\u00f6ttingen 37075 ,","place":["Germany"]},{"name":"FORUM Cardiology , Rosdorf ,","place":["Germany"]},{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"2025062713222004700_qyaf077-B1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of 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