Cardiovascular function assessed by invasive cardiopulmonary exercise testing in patients who have heart failure and normal systolic function (open boxes) and age-matched normal controls (closed boxes). The primary components of the Fick equation for VO2, cardiac output, and A-VO2 difference are shown in panels A and B, respectively. The components of cardiac output, stroke volume, and heart rate are shown in panels C and D. The X-axis is exercise workload in kilopounds/min (kpm); 150 kpm is equivalent to 25 W. (From Kitzman DW, Higginbotham MB, Cobb FR, et al. Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol 1991;17:1065-72; with permission. Copyright © 1991, American College of Cardiology.)