“…In POH, the accumulation of ECM and eventual myocardial fibrosis significantly contributes to LV function. In particular, enhanced synthesis and deposition of myocardial ECM is directly associated with increased LV myocardial stiffness properties, which in turn causes poor filling characteristics during diastole (12,35,159,191,194,312,314,421,488). Indeed, recent clinical evidence suggests that progressive ECM accumulation and diastolic dysfunction are important underlying pathophysiological mechanisms for heart failure in patients with POH (196,544,545).…”