{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:41:29Z","timestamp":1793810489513,"version":"4.6.1"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2022,8,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent trial data suggest that stratification of patients with heart failure with preserved ejection fraction (HFpEF) according to left ventricular ejection fraction (LVEF) provides a means for dissecting different treatment responses. However, the differential pathophysiologic considerations have rarely been described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective, single-center study analyzed consecutive symptomatic patients with HFpEF diagnosed according to the 2016 European Society of Cardiology heart failure guidelines. Patients were grouped into LVEF 50% to 60% and LVEF &gt;60% cohorts. All patients underwent cardiac magnetic resonance imaging. Transfemoral cardiac catheterization was performed to derive load-dependent and load-independent left ventricular (LV) properties on pressure\u2013volume loop analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fifty-six patients with HFpEF were enrolled and divided into LVEF 50% to 60% (n=21) and LVEF &gt;60% (n=35) cohorts. On cardiac magnetic resonance imaging, the LVEF &gt;60% cohort showed lower LV end-diastolic volumes (\n                      <jats:italic>P<\/jats:italic>\n                      =0.019) and end-systolic volumes (\n                      <jats:italic>P<\/jats:italic>\n                      =0.001) than the LVEF 50% to 60% cohort; stroke volume (\n                      <jats:italic>P<\/jats:italic>\n                      =0.821) did not differ between the cohorts. Extracellular volume fraction was higher in the LVEF 50% to 60% cohort than in the LVEF &gt;60% cohort (0.332 versus 0.309;\n                      <jats:italic>P<\/jats:italic>\n                      =0.018). Pressure-volume loop analyses demonstrated higher baseline LV contractility (end-systolic elastance, 1.85 vs 1.33 mm Hg\/mL;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) and passive diastolic stiffness (\u03b2 constant, 0.032 versus 0.018;\n                      <jats:italic>P<\/jats:italic>\n                      =0.004) in the LVEF &gt;60% cohort. Ventriculo-arterial coupling (end-systolic elastance\/arterial elastance) at rest was in the range of optimized stroke work in the LVEF &gt;60% cohort but was impaired in the LVEF 50% to 60% cohort (1.01 versus 0.80;\n                      <jats:italic>P<\/jats:italic>\n                      =0.005). During handgrip exercise, patients with LVEF &gt;60% had higher increases in end-systolic elastance (1.85 versus 0.82 mm Hg\/mL;\n                      <jats:italic>P<\/jats:italic>\n                      =0.023), attenuated increases in indexed end-systolic volume (\u22121 versus 7 mL\/m\u00b2;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.004), and more exaggerated increases in LV filling pressures (8 vs 5 mm Hg;\n                      <jats:italic>P<\/jats:italic>\n                      =0.023). LV stroke volume decreased in the LVEF &gt;60% cohort (\n                      <jats:italic>P<\/jats:italic>\n                      =0.007) under exertion.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patients with HFpEF in whom LVEF ranged from 50% to 60% demonstrated reduced contractility, impaired ventriculo-arterial coupling, and higher extracellular volume fraction. In contrast, patients with HFpEF and a LVEF &gt;60% demonstrated a hypercontractile state with excessive LV afterload and diminished preload reserve. A LVEF-based stratification of patients with HFpEF identified distinct morphologic and pathophysiologic subphenotypes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.122.059280","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T14:00:30Z","timestamp":1660572030000},"page":"506-518","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":148,"title":["Characteristics of Heart Failure With Preserved Ejection Fraction Across the Range of Left Ventricular Ejection Fraction"],"prefix":"10.1161","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4380-4821","authenticated-orcid":true,"given":"Sebastian","family":"Rosch","sequence":"first","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-6751","authenticated-orcid":true,"given":"Karl-Patrik","family":"Kresoja","sequence":"additional","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8082-6472","authenticated-orcid":true,"given":"Christian","family":"Besler","sequence":"additional","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Fengler","sequence":"additional","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Rebecca","family":"Sch\u00f6ber","sequence":"additional","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3939-2139","authenticated-orcid":true,"given":"Maximilian","family":"von Roeder","sequence":"additional","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"L\u00fccke","sequence":"additional","affiliation":[{"name":"Radiology (C.L., M.G.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Gutberlet","sequence":"additional","affiliation":[{"name":"Radiology (C.L., M.G.), Heart Center Leipzig at University of Leipzig, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-2498","authenticated-orcid":true,"given":"Karin","family":"Klingel","sequence":"additional","affiliation":[{"name":"Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital T\u00fcbingen, Germany (K.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-998X","authenticated-orcid":true,"given":"Holger","family":"Thiele","sequence":"additional","affiliation":[{"name":"Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, 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