{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T11:08:33Z","timestamp":1779966513353,"version":"3.53.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early-stage heart failure with preserved ejection fraction (HFpEF) is like hypertensive heart disease (HHD) at resting echocardiography, but increases left ventricular (LV) filling pressure during stress. Coronary microvascular dysfunction (CMD) is a pathogenetic mechanism of HFpEF. Whether CMD actively increases LV filling pressure when LV stiffness is not yet established at rest remains unknown. LV mechanics were evaluated using dipyridamole stress echocardiography (DipSE) in suspected early-stage HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 30 patients (mean age: 76 years; 80% female) with suspected early-stage HFpEF and 33 with HHD and normal NT-proBNP underwent DipSE. Systolic and diastolic indexes of LV myocardial function, particularly E\/e\u2032, isovolumic contraction and relaxation times (IVCT and IVRT), and ejection time (ET), were measured at rest and during stress. The myocardial performance index (MPI) was calculated as IVCT\u2009+\u2009IVRT\/ET.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      E\/e\u2032 ratio increased in suspected early-stage HFpEF patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), but not in HHD patients. During stress, the IVRT reduced in HHD patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), whereas remained significantly higher in suspected early-stage HFpEF patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Thus, MPI improved during DipSE in HHD patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), but not in suspected early-stage HFpEF patients. Particularly, MPI was worse in suspected early-stage HFpEF patients with ST-segment depression than in those without it (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In suspected early-stage HFpEF, increased LV filling pressure during DipSE is associated with abnormal active myocardial relaxation. Myocardial performance is particularly impaired in patients with ST-segment depression during DipSE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1744083","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T11:01:22Z","timestamp":1779966082000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Abnormal active myocardial relaxation by dipyridamole stress test in suspected early-stage heart failure with preserved ejection fraction: a retrospective exploratory analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Gabriella","family":"Locorotondo","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Filice","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Augusta","family":"Gabrielli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Moretti","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Laboratory Medicine, Unity of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. 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Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonarda","family":"Galiuto","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019Andrea University Hospital","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1093\/eurheartj\/ehw461","article-title":"The parallel tales of microvascular angina and heart failure with preserved ejection fraction: a paradigm shift","volume":"38","author":"Crea","year":"2017","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e002562","DOI":"10.1161\/CIRCHEARTFAILURE.115.002562","article-title":"Reduced myocardial flow in heart failure patients with preserved ejection fraction","volume":"9","author":"Srivaratharajah","year":"2016","journal-title":"Circ Heart Fail"},{"key":"B3","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.cardfail.2017.10.010","article-title":"Reduced myocardial flow reserve is associated with diastolic dysfunction and decreased left atrial strain in patients with normal ejection fraction and epicardial perfusion","volume":"24","author":"Konerman","year":"2018","journal-title":"J Card Fail"},{"key":"B4","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1093\/eurheartj\/ehx721","article-title":"Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction","volume":"39","author":"Taqueti","year":"2017","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1161\/CIRCHEARTFAILURE.113.000823","article-title":"Pulmonary hypertension in heart failure preserved ejection fraction: prevalence, pathophysiology, and clinical perspectives","volume":"7","author":"Guazzi","year":"2014","journal-title":"Circ Heart Fail"},{"key":"B6","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/0002-9149(87)90295-5","article-title":"Usefulness of a high-dose dipyridamole-echocardiography test for diagnosis of syndrome X","volume":"60","author":"Picano","year":"1987","journal-title":"Am J Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/ejhf.2333","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 Cardiology (ESC). with the special contribution of the heart failure association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"B8","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.118.034646","article-title":"A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction","volume":"138","author":"Reddy","year":"2018","journal-title":"Circulation"},{"key":"B9","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/0002-9149(86)90771-X","article-title":"Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings","volume":"57","author":"Devereux","year":"1986","journal-title":"Am J Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1002\/clc.20932","article-title":"Usefulness of tissue Doppler imaging-myocardial performance Index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction","volume":"34","author":"Kim","year":"2011","journal-title":"Clin. 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