Fig. 4.

(A) With aging, hypertension, and in HFpEF, ventricular (Ees) and arterial (Ea) stiffness increases. Although the Ea/Ees ratio may remain normal, combined ventricular and vascular stiffening leads to marked fluctuations in blood pressure with relatively small changes in preload or afterload. This condition is in striking contrast to heart failure with low EF (see Fig. 3B). (B) LV (black) and pulmonary artery (red) pressure tracings from an 81-year-old woman who has HFpEF demonstrating severe systemic and pulmonary artery hypertension, with markedly elevated LVEDP and wedge pressures (not shown). (C) In response to a very low dose of sodium nitroprusside (2 μg), filling pressures normalize, but severe hypotension develops. Note that there is little change in cardiac output (stroke volume) with vasodilation, again in striking contrast to heart failure with reduced EF. CO, cardiac output; PVR, pulmonary vascular resistance; PWP, pulmonary wedge pressure; WU, Wood units.