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Although the etiology and pathophysiology of INOCA and HFpEF are complex and not fully understood, there is no doubt that the underlying cause of both conditions is endothelial dysfunction (ED) which further promotes the development of left ventricular diastolic dysfunction (LVDD).The stage of diastolic dysfunction correlates with the impairment of exercise capacity in patients without myocardial ischemia better than resting left ventricular ejection fraction (LVEF). 5 In patients with heart failure, the stage of diastolic dysfunction is a stronger predictor of mortality than ejection fraction. 1.
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