Abnormal Haemodynamic Response to Exercise in Heart Failure with Preserved Ejection Fraction
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Aims: Peak oxygen uptake (VO2) is diminished in patients with heart failure with preserved ejection fraction (HFpEF) suggesting impaired cardiac reserve. To test this hypothesis, we assessed the haemodynamic response to exercise in HFpEF patients. Methods and results: Eleven HFpEF patients (73 ± 7 years, 7 females/4 males) and 13 healthy controls (70 ± 4 years, 6 females/7 males) were studied during submaximal and maximal exercise. The cardiac output (Qc, acetylene rebreathing) response to exercise was determined from linear regression of Qc and VO2 (Douglas bags) at rest, ∼30% and ∼60% of peak VO2, and maximal exercise. Peak VO2 was lower in HFpEF patients than in controls (13.7 ± 3.4 vs. 21.6 ± 3.6 mL/kg/min; P < 0.001), while indices of cardiac reserve were not statistically different: peak cardiac power output [CPO = Qc × mean arterial pressure (MAP); HFpEF 1790 ± 509 vs. controls 2119 ± 581 L/mmHg/min; P = 0.20]; peak stroke work [SW = stroke volume (SV) × MAP; HFpEF 13 429 ± 2269 vs. controls 13 200 ± 3610 mL/mmHg; P = 0.80]. The ΔQc/ΔVO2 slope was abnormally elevated in HFpEF patients vs. controls (11.2 ±3.6 vs. 8.3 ± 1.5; P = 0.015). Conclusion: Contrary to our hypothesis, cardiac reserve is not significantly impaired in well-compensated outpatients with HFpEF. The abnormal haemodynamic response to exercise (decreased peak VO2, increased ΔQc/ΔVO2 slope) is similar to that observed in patients with mitochondrial myopathies, suggesting an element of impaired skeletal muscle oxidative metabolism. This impairment may limit functional capacity by two mechanisms: (i) premature skeletal muscle fatigue and (ii) metabolic signals to increase the cardiac output response to exercise which may be poorly tolerated by a left ventricle with impaired diastolic function.
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In older patients with HF (mean age ≥70 years), peak VO2 during upright treadmill or cycle exercise is ≈30% lower than in age-matched healthy subjects, and the magnitude of the reduction is independent of HF phenotype.
“Studies by Kitzman et al185 and others186–188 found that in older patients with HF (mean age ≥70 years), peak V˙o2 during upright treadmill or cycle exercise is ≈30% lower than in age-matched healthy subjects, and the magnitude of the reduction is independent of HF phenotype (ejection fraction).186”
The peak VO2 of a typical older patient with HF (≈14 mL·kg−1·min−1) is well below the established threshold value of 18 mL·kg−1·min−1 distinguishing between high and low physical function.
“The peak V˙o2 of a typical older patient with HF (≈14 mL·kg−1·min−1)185–188 is also well below the established threshold value (ie, 18 mL·kg−1·min−1),125 distinguishing between high and low physical function.”
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- Authors
- Bhella, P. S., Prasad, A., Heinicke, K., Hastings, J. L., Arbab-Zadeh, A., Adams-Huet, B., Pacini, E. L., Shibata, S., Palmer, M. D., Newcomer, B. R., & Levine, B. D.
- Affiliations
- John Peter Smith Hospital (US)
- Institute for Exercise and Environmental Medicine (US)
- The University of Texas-Southwestern Medical Center at Dallas , TX ,
- The Institute for Exercise and Environmental Medicine , 7232 Greenville Ave, Suite 435, Dallas, TX, 75231 ,
- The University of Texas Southwestern Medical Center (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Levine, Benjamin D.
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-12-01
- Volume
- 13
- Issue
- 12
- Pages
- 1296-1304
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- PMC
- PMC3220394
- OpenAlex
- W2032411667
- Cited by
- 238
- References
- 32
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 14 · 2023: 16 · 2022: 18 · 2021: 11 · 2020: 16 · 2019: 13 · 2018: 19 · 2017: 21 · 2016: 17 · 2015: 25 · 2014: 26 · 2013: 16 · 2012: 9
- FWCI
- 43.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (AG17479, RR024982)
- National Institute on Aging (R01 AG17479, R01AG017479)
- National Center for Research Resources (UL1RR024982)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- heart failure with preserved ejection fraction, exercise hemodynamics, peak oxygen uptake, cardiac reserve, cardiac output, stroke work, cardiac power output, skeletal muscle oxidative metabolism, mitochondrial myopathy, diastolic dysfunction, exercise intolerance
- MeSH terms
- Aged, Echocardiography, Electrocardiography, Exercise Test, Female, Follow-Up Studies, Heart Failure, Hemodynamics, Humans, Male, Myocardium, Magnetic Resonance Spectroscopy, Oxygen Consumption, Stroke Volume, Ventricular Function, Left, Exercise Tolerance, Disease Progression
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