Gorter TM, et al. - Researchers investigated the impact of pulmonary vascular disease (PVD) on the pathophysiology of exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). They examined three groups of HFpEF patients with elevated pulmonary capillary wedge pressure (≥ 15 mmHg) at rest: non-pulmonary hypertension (PH)-HFpEF, PH but no PVD (isolated post-capillary PH, IpcPH), and PH with PVD (combined post- and pre-capillary PH, CpcPH). They found unique hemodynamic limitations were shown in HFpEF patients with PVD during exercise, including impaired recruitment of LV preload due to excessive right heart congestion and blunted RV systolic reserve, both of which constrained aerobic capacity.