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. Author manuscript; available in PMC: 2019 Jul 3.
Published in final edited form as: J Am Coll Cardiol. 2018 Jul 3;72(1):29–40. doi: 10.1016/j.jacc.2018.04.039

Central illustration. Conceptual Model Linking Myocardial Injury, LV Diastolic and Systolic Reserve Limitation, and Hemodynamic Derangements during Exercise in HFpEF.

Central illustration

Coronary microvascular dysfunction may contribute to microvascular/subendocardial ischemia and subsequent cardiomyocyte injury, especially in the setting of myocardial O2 supply-demand imbalance. This cardiomyocyte injury may worsen LV diastolic and systolic reserve limitation and cause elevation in LV filling pressure and impairment in cardiac output reserve. Conversely, increase in LV filling pressure that develops secondary to LV reserve dysfunction may lead to cardiomyocyte injury possibly due to myocardial O2 supply-demand mismatch and subendocardial ischemia, or possibly both exacerbating each other. O2 indicates oxygen; NO, nitric oxide; and other abbreviations as in Figures 1 and 4.