Figure 3.

The potential causal web of clinical correlates for MVD and HFpEF. Clinical correlates affect both microvascular dysfunction (MVD) and heart failure with preserved ejection fraction (HFpEF), and in a bi-directional manner, creating a complex causal web. Yet, these clinical factors could also influence HFpEF development and progression through other mediating mechanisms (dotted lines) that are to be further elucidated. Moreover, the specificity of microvascular abnormalities for HFpEF requires further research. Causality of the clinical factors with systemic MVD and how this would drive HFpEF is still a knowledge gap.