Figure 2.

Cardiac and noncardiac factors linking endothelial dysfunction and exercise intolerance in HFpEF. Besides diastolic dysfunction, which is well known, recent evidence implicates other cardiac (orange) and noncardiac (blue) factors in the development of exercise intolerance in HFpEF. Endothelial dysfunction is an underlying mechanism of many factors associated with exercise intolerance. The “inflammatory microvascular dysfunction” hypothesis puts endothelial dysfunction at the root of LV hypertrophy and LV stiffness. Endothelial dysfunction is also a precursor of atherosclerosis and contributes to many noncardiac factors implicated in exercise intolerance. HFpEF = heart failure with preserved ejection fraction, LA = left atrium, LV = left ventricle.