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[Comment] Left-to-right atrial shunting: new hope for heart failure?

So far, no treatments have proven effective for heart failure with preserved ejection fraction—a syndrome with dismal prognosis.1 The syndrome is heterogeneous and associated with many comorbidities. Pathophysiology of the disorder is poorly understood, although a common hallmark is large artery stiffness and heart stiffness, whether related to fibrosis or myocardial titin-based stiffness. As a consequence, the heart’s ability to cope with exercise-induced haemodynamic overload is restricted. Exercise would inevitably produce an abrupt rise in pulmonary and left atrial pressure, the main driver of dyspnoea in patients with heart failure with preserved ejection fraction.