## 3 Results  
Of a total of 49 subjects, we excluded 19 because of: LVEF < 53% (\(n\) = 4), more than mild valvular disease (\(n\) = 4), atrial fibrillation (\(n\) = 2), inadequate echocardiographic imaging (\(n\) = 3), and drop-out at follow-up (\(n\) = 10). The remaining 30 patients were included in this analysis (Figure 1).  
The mean age was 64 + 7.6 years. At baseline, 11 patients had arterial hypertension, 7 were dyslipidemia, 8 were smokers, none were diagnosed with chronic obstructive pulmonary disease (COPD) and diabetes mellitus, and only 1 patient presented with peripheral arterial disease. Patient characteristics at enrollment and after 6 months of treatment with tadalafil are reported in Table 1.  
Figure 1: Patient flow and study design.  
Echocardiographic data were collected at 3 and 6 months for all patients. After 3 months of treatment with tadalafil, no difference was found between echocardiographic parameters, as reported in Table 2.  
At 6 months, there was no significant variation in standard echocardiographic parameters, but E/e\({}^{\prime}\) ratio, peak velocity of TR jet, and PAPs were significantly lower, as reported in Table 3 (Figure 2).  
\begin{table}
\begin{tabular}{c c c c} \hline  & **Baseline** & **At 6 Months** & \(p\)**-Value** \\ \hline SBP (mm Hg) & 127 \(\pm\) 13 & 129 \(\pm\) 16 & 0.71 \\ DBP (mm Hg) & 73.6 \(\pm\) 7.9 & 75.7 \(\pm\) 8.7 & 0.33 \\ HR (bpm) & 72.0 \(\pm\) 10.7 & 69.2 \(\pm\) 10.5 & 0.45 \\ BW (kilograms) & 78.6 \(\pm\) 8.5 & 77.3 \(\pm\) 9.7 & 0.49 \\ \hline BW = body weight; DBP = diastolic blood pressure; SBP = systolic blood pressure; HR = heart rate. & & \\ \end{tabular}
\end{table}
Table 1: Characteristics of the patients at baseline and after 6 months of treatment with tadalafil.  
\begin{table}
\begin{tabular}{c c c c} \hline  & **Baseline** & **At 3 Months** & \(p\)**-Value** \\ \hline LVM/h\({}^{2.7}\) (g/m\({}^{2.7}\)) & 35.0 \(\pm\) 7.0 & 36.1 \(\pm\) 10.1 & 0.54 \\ RWT & 0.37 \(\pm\) 0.6 & 0.35 \(\pm\) 0.5 & 0.53 \\ E/e\({}^{\prime}\) ratio & 7.4 \(\pm\) 2.7 & 6.9 \(\pm\) 1.4 & 0.2 \\ TAPSE (mm) & 23.9 \(\pm\) 3.5 & 23.2 \(\pm\) 4.0 & 0.56 \\ TR vel (m/s) & 2.4 \(\pm\) 0.2 & 2.3 \(\pm\) 0.2 & 0.8 \\ LAVi (mL/m\({}^{2}\)) & 28.4 \(\pm\) 6.8 & 37.8 \(\pm\) 5.2 & 0.3 \\ EF (\%) & 60.4 \(\pm\)4.9 & 60.7 \(\pm\) 3.3 & 0.9 \\ GLS (\%) & 21.0 \(\pm\) 1.6 & 20.8 \(\pm\) 1.6 & 0.7 \\ PAPs (mmHg) & 27.3 \(\pm\) 3.6 & 26.0 \(\pm\) 6.0 & 0.36 \\ \hline \end{tabular}
\end{table}
Table 2: Echocardiographic findings at 3 months of treatment with tadalafil.  
\begin{table}
\begin{tabular}{c c c c} \hline  & **Baseline** & **At 3 Months** & \(p\)**-Value** \\ \hline LVM/h\({}^{2.7}\) (g/m\({}^{2.7}\)) & 35.0 \(\pm\) 7.0 & 36.1 \(\pm\) 10.1 & 0.54 \\ RWT & 0.37 \(\pm\) 0.6 & 0.35 \(\pm\) 0.5 & 0.53 \\ E/e\({}^{\prime}\) ratio & 7.4 \(\pm\) 2.7 & 6.9 \(\pm\) 1.4 & 0.2 \\ TAPSE (mm) & 23.9 \(\pm\) 3.5 & 23.2 \(\pm\) 4.0 & 0.56 \\ TR vel (m/s) & 2.4 \(\pm\) 0.2 & 2.3 \(\pm\) 0.2 & 0.8 \\ LAVi (mL/m\({}^{2}\)) & 28.4 \(\pm\) 6.8 & 37.8 \(\pm\) 5.2 & 0.3 \\ EF (\%) & 60.4 \(\pm\)4.9 & 60.7 \(\pm\) 3.3 & 0.9 \\ GLS (\%) & 21.0 \(\pm\) 1.6 & 20.8 \(\pm\) 1.6 & 0.7 \\ PAPs (mmHg) & 27.3 \(\pm\) 3.6 & 26.0 \(\pm\) 6.0 & 0.36 \\ \hline \end{tabular}
\end{table}
Table 3: Echocardiographic findings at 6 months of treatment with tadalafil.