{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:27:22Z","timestamp":1787372842755,"version":"build-2736575974"},"reference-count":70,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure in which the ejection fraction remains within the normal range (\u226550%); however, patients still experience typical symptoms of heart failure. One of the most common manifestations in this population is exercise intolerance, which in some cases may be the only presenting symptom. Exercise intolerance refers to a reduced capacity to perform physical activity. Several processes, including impaired cGMP\u2013PKG signaling, increased collagen deposition, endothelial dysfunction, increased arterial stiffness, pulmonary hypertension, and vascular remodeling, contribute to the pathophysiology of HFpEF. The disruption of these fundamental physiological processes significantly impairs exercise capacity, leading to attenuated increases in heart rate, stroke volume, and\/or contractility, along with abnormal ventricular\u2013vascular coupling during exertion. When EI is suspected, a spectrum of diagnostic modalities\u2014from simple, low-cost tools such as the 6 min walk test to advanced imaging\u2014can be used to evaluate its presence and its association with HFpEF. When EI in HFpEF is diagnosed, management should focus on addressing this limitation to improve quality of life and reduce morbidity and mortality. Exercise training and pharmacological therapies, such as SGLT2 inhibitors, may be beneficial in this population. In conclusion, EI is a common manifestation of HFpEF that significantly impacts patients\u2019 quality of life. Understanding its underlying mechanisms and addressing it appropriately are essential to improving patient outcomes.<\/jats:p>","DOI":"10.3390\/pathophysiology33030063","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:05:19Z","timestamp":1787241919000},"page":"63","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Exercise Intolerance and Evaluation for HFpEF: A Literature Review of Pathophysiology, Diagnosis, and Management"],"prefix":"10.3390","volume":"33","author":[{"given":"Ali","family":"Moradi","sequence":"first","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Ramey","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kutiba","family":"Tabbaa","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5432-4047","authenticated-orcid":false,"given":"Abdullah","family":"Sahyouni","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Sanchez Garcez","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6978-8948","authenticated-orcid":false,"given":"Shivanshu","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine, USF Health Morsani College of Medicine, Tampa, FL 33602, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4960-4795","authenticated-orcid":false,"given":"Elaine","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Medicine, USF Health Morsani College of Medicine, Tampa, FL 33602, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5442-8152","authenticated-orcid":false,"given":"Grant","family":"Barton","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2780-4482","authenticated-orcid":false,"given":"Olugbenga","family":"Oyesanmi","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Subbiondo","sequence":"additional","affiliation":[{"name":"HCA Florida Blake Hospital, University of South Florida (USF) Morsani College of Medicine, Bradenton, FL 34209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.jacc.2017.04.025","article-title":"2017 ACC\/AHA\/HFSA focused update of the 2013 ACCF\/AHA guideline for the management of heart failure: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America","volume":"70","author":"Yancy","year":"2017","journal-title":"J. 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