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| Variable | Abnormality | Functional correlate |
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| Endothelial dysfunction | Increased circulating levels of IL-6 and TNF-α.
Increased endothelial production of ROS. | Increased myocyte stiffness. |
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| Reduced microvascular density | Microvascular rarefaction. | Increased myocardial fibrosis. |
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| Peripheral vascular dysfunction | Increased central arterial stiffness and increased magnitude of arterial wave reflections. | Increased afterload.
Increased LVH. |
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| Impaired skeletal muscle vasodilatory reserve during exercise | Results in a blunted exercise-induced reduction in systemic vascular resistance and presumed abnormal skeletal muscle oxygen delivery. | Exercise intolerance. |
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| Pulmonary hypertension | Due to pulmonary vascular remodeling secondary to sustained pulmonary venous pressure elevation, primary abnormalities in pulmonary arterial function, and abnormal right ventricle RV–PA coupling. | Exercise intolerance and dyspnea on exertion. |
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| Lung disease | Airflow limitation | Exercise intolerance. |
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| Obstructive sleep apnea | Impairs LV diastole | Begets LVH and may hasten HFpEF progression. |
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| Chronic kidney disease | Adverse outcomes
CKD is associated with worse outcomes in HFpEF rather in HFrEF | RV/LV remodeling and LV longitudinal systolic dysfunction.
Poor diuretic response. |
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| Atrial fibrillation | Increased LA stiffness and greater LA pulsatility | Associated with aging and results in more hospitalizations and poor prognosis independent of stroke risk |
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| Frailty | Increased with unhealthy aging. | More comorbidities and associated with greater ED visits and hospitalizations. |
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