1. M. JESSUP Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano 9 - 10 aprile 2010

2. Heart Failure in Women Diastolic Heart Failure: a Matter of Not Compliant Myocardium Mariell Jessup MD, FAHA, FACC Professor of Medicine University of Pennsylvania

4. Fonarow et al. JACC 2007; 50:768 OPTIMIZE-HF

8. 312 patients, mean age:66 years, LVEF: 50%, 34% women. The median follow-up was 18.7 months. Diastolic dysfunction: 67% of classified patients moderate and severe DD: 44%

9. JACC 2007; 49: 687 CHARM

10. Serum markers of fibrosis (CITP and PIIINP) are associated with systolic and diastolic HF in community-dwelling elderly individuals. These associations remained significant even after adjustment for demographic and clinical characteristics, bone mineral density and NT-proBNP.

11. Stress does not commonly induce systolic dysfunction in patients with HFNEF. It is unlikely that exercise intolerance is due to global regional or long-axis systolic dysfunction or other non- cardiac causes. Abnormalities in diastolic function are often induced or exacerbated by stress in these patients, Stress-induced impairment of early diastolic relaxation with consequent rise in the LV end-diastolic pressure is the likely cause of exercise intolerance.

15. Diastolic Heart Failure: a Matter of Not Compliant Myocardium Women age their hearts differently than men, setting the stage for less compliant myocardium. Heart rate response is also not normal in HFpEF. The abnormal myocardium is not just more fibrotic. Other aging factors and multiple co-morbidities must play a role.