Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem

Area of Science:

• Cardiology
• Geriatrics
• Exercise Physiology

Background:

• Heart failure with preserved ejection fraction (HFpEF) is the predominant form of heart failure in the aging population.
• HFpEF prevalence is rising disproportionately to HF with reduced ejection fraction (HFrEF), with a worsening prognosis compared to improving HFrEF outcomes.
• Pathophysiology and optimal treatments for HFpEF remain incompletely understood, despite its clinical significance.

Purpose of the Study:

• To investigate the underlying mechanisms of reduced exercise tolerance in patients with HFpEF.
• To differentiate between central (cardiac) and peripheral factors contributing to functional limitations in HFpEF.
• To inform the development of targeted therapeutic strategies for improving exercise capacity in HFpEF.

Main Methods:

• Review of current understanding of HFpEF pathophysiology, focusing on exercise limitation mechanisms.
• Analysis of findings from clinical trials investigating interventions for HFpEF.
• Comparison of central hemodynamic function with peripheral adaptive mechanisms in response to exercise.

Main Results:

• Reduced exercise tolerance is a key characteristic of HFpEF, impacting quality of life.
• Traditional focus on central cardiac dysfunction may not fully explain exercise limitations in HFpEF.
• Physical training can enhance exercise tolerance through peripheral adaptations, independent of central cardiac function improvements.

Conclusions:

• Peripheral limitations play a significant role in exercise intolerance, a hallmark of HFpEF.
• Current drug trials targeting central cardiovascular function have not improved exercise capacity in HFpEF.
• Further research into peripheral mechanisms is crucial for developing effective HFpEF treatments.