{
  "abstract": "BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) and right ventricular (RV)-pulmonary arterial (PA) uncoupling, as assessed by a decrease ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) on echocardiography, have poorer outcomes than patients without RV-PA uncoupling. METHODS AND RESULTS: The MONACO trial was an adaptive, randomized, double-blind, placebo-controlled study that enrolled hospitalized patients with HFpEF admitted to 12 centers in Japan. Patients who had left ventricular ejection fraction ≥50% and TAPSE/PASP <0.57 mm/mmHg at discharge were randomized 1 : 1 to receive pimobendan 1.25 mg b.i.d. or placebo. The primary objective was to evaluate changes from baseline (day 0) to day 30 in exercise capacity measured by the 6-minute walking test. Enrollment was terminated due to the invalid result of the planned interim analysis. The median age of participants was 82 years and 46% were women. Pimobendan (n=24) or placebo (n=26) was administrated orally. At day 30, mean changes in 6-minute walking distance in patients who received pimobendan (+26.9 m [95% confidence interval; -2.0, +55.8]) or placebo (+21.4 m [95% confidence interval; -14.3, +57.2]) were not significantly different (P=0.402). CONCLUSIONS: Among patients with HFpEF and RV-PA uncoupling, administration of pimobendan for 30 days did not result in significant improvement in exercise capacity compared with placebo.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 24,
  "authors": [
    {
      "name": "Akito Nakagawa"
    },
    {
      "name": "Yuki Matsuoka"
    },
    {
      "name": "Masahiro Seo"
    },
    {
      "name": "Haruhiko Abe"
    },
    {
      "name": "Yusuke Nakagawa"
    },
    {
      "name": "Takeshi Masaki"
    },
    {
      "name": "Shinichiro Suna"
    },
    {
      "name": "Yasuhiro Akazawa"
    },
    {
      "name": "Kei Nakamoto"
    },
    {
      "name": "Toshiaki Mano"
    },
    {
      "name": "Masamichi Yano"
    },
    {
      "name": "Masayuki Hirai"
    },
    {
      "name": "Katsuomi Iwakura"
    },
    {
      "name": "Toshiaki Yokoi"
    },
    {
      "name": "Tomomi Yamada"
    },
    {
      "name": "Satomi Okamura"
    },
    {
      "name": "Takahisa Yamada"
    },
    {
      "name": "Yoshio Yasumura"
    },
    {
      "name": "Akihiro Sunaga"
    },
    {
      "name": "Katsuki Okada"
    },
    {
      "name": "Daisaku Nakatani"
    },
    {
      "name": "Yohei Sotomi"
    },
    {
      "name": "Shungo Hikoso"
    },
    {
      "name": "Yasushi Sakata"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ea0rge63w2ym3.bib",
  "cited_by": 1,
  "doi": "10.1253/circj.cj-26-0152",
  "fulltext_url": "https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0152/_article",
  "id": "ea0rge63w2ym3",
  "issns": [
    "1347-4820",
    "1346-9843"
  ],
  "landing_url": "https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0152/_article",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "jstage-journal",
      "medicine/cardiovascular"
    ],
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7165048248",
  "pdf_url": "https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0152/_pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ea0rge63w2ym3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:24Z",
      "native_id": "10.1253/circj.cj-26-0152",
      "source": "jstage",
      "url": "https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0152/_article"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Pimobendan in Heart Failure With Preserved Ejection Fraction and Right Ventricular–Pulmonary Arterial Uncoupling ― A Randomized Clinical Trial ―",
  "title_text": "Pimobendan in Heart Failure With Preserved Ejection Fraction and Right Ventricular–Pulmonary Arterial Uncoupling ― A Randomized Clinical Trial ―",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:24Z",
  "url": "https://research.draconitic.com/paper/ea0rge63w2ym3",
  "venue": "Circulation Journal",
  "versions": []
}