Exercise-Induced Out-Of-Proportion Increase in Afterload and Impaired Right Ventricular Contractile Reserve in HFpEF

Resting RV afterload elevation in HFpEF results in a compensatory increase in contractility. Out-of-proportion increase of afterload paralleled by inadequate increase in contractility results in failure to increase the cardiac index in HFpEF, potentially associated with exertional functional failure.