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. 2018 Jun 26;39(30):2825–2835. doi: 10.1093/eurheartj/ehy331

Figure 3.

Figure 3

Ventricular interdependence with exercise in heart failure with preserved ejection fraction and pulmonary vascular disease. (A) Increase in venous return during exercise was associated with more dramatic increase in right atrial pressure in CpcPH-HFpEF compared to the other HFpEF groups. (B) While patients with non-PH-HFpEF and IpcPH-HFpEF displayed an increase in left ventricular transmural pressure, CpcPH-HFpEF patients developed a paradoxical decrease in left ventricular transmural pressure as venous return to the right heart increased during exercise. (C–D) The reduction in left ventricular transmural pressure was increased as exercise pulmonary vascular resistance and transpulmonary gradient increased, indicating that left heart underfilling was directly related to the severity of pulmonary vascular disease. Error bars reflect standard error of the mean. aP < 0.05 vs. Non-PH-HFpEF; and bP < 0.05 vs. IpcPH-HFpEF. CpcPH, combined post- and pre-capillary pulmonary hypertension; IpcPH, isolated post-capillary pulmonary hypertension; LVTMP, left ventricular transmural pressure; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; RAP, right atrial pressure; TPG, transpulmonary gradient.