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Correlation between longitudinal strain analysis and coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction.

Heart failure with preserved ejection fraction (HFpEF) has overtaken heart failure in the setting of reduced ejection fraction as the most common form of heart failure and now comprises more than 50% of all patients with heart failure [1]. In a recently published work, Paulus et al. hypothesizes that endothelial dysfunction of the coronary microcirculation may alter the paracrine cross-talk signaling pathway between the coronary microcirculation and cardiomyocyte, through a reduction in the NO and downstream bioavailability of both cyclic guanosine monophosphate (cGMP) and protein kinase G (PKG) activity.

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