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Heart failure classification based on resting ejection fraction does not display a unique exercise response pattern

Simon Wernhart1, Maria Papathanasiou1, Tienush Rassaf1

  • 1University Hospital Essen, University Duisburg-Essen, West German Heart- and Vascular Center, Department of Cardiology and Vascular Medicine, Hufelandstrasse 55, 45147 Essen, Germany.

International Journal of Cardiology
|January 30, 2023
PubMed

Insights

Heart failure with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF) do not show distinct cardiopulmonary exercise testing (CPET) profiles. CPET variables may help better define heart failure phenotypes beyond ejection fraction categories.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Heart Failure Research

Background:

  • The categorization of heart failure (HF) into preserved (HFpEF), mildly reduced (HFmrEF), and reduced (HFrEF) ejection fraction (EF) is debated.
  • It remains unclear if these HF classifications correspond to distinct exercise limitation patterns identified through cardiopulmonary exercise testing (CPET).
  • This study investigates differences in CPET variables across the three main HF categories.

Purpose of the Study:

  • To determine if cardiopulmonary exercise testing (CPET) variables differ significantly among patients with heart failure with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF).
  • To assess the utility of CPET in characterizing heart failure phenotypes beyond traditional ejection fraction-based classifications.

Main Methods:

  • Analysis of CPET variables from stable patients diagnosed with HFpEF (n=123), HFmrEF (n=31), and HFrEF (n=153).
  • The primary outcome was the association between HF category and peak oxygen consumption (VO2peak).
  • Secondary outcomes included the association between HF category and oxygen uptake efficiency slope (OUES) and the increase of O2 pulse (ΔO2 pulse).

Main Results:

  • Peak oxygen consumption (VO2peak) showed a significant decline across all HF categories (HFpEF > HFmrEF > HFrEF, p < 0.001).
  • Oxygen uptake efficiency slope (OUES) differed significantly between HFpEF and HFrEF (p < 0.001), and between HFmrEF and HFrEF (p = 0.004).
  • The increase of O2 pulse (ΔO2 pulse) differed between HFpEF and HFrEF (p < 0.001), and between HFpEF and HFmrEF (p = 0.049). No significant differences were observed in CPET variables between HFrEF patients with and without LVAD support.

Conclusions:

  • Heart failure, irrespective of ejection fraction category, does not exhibit a distinct cardiopulmonary exercise testing (CPET) profile.
  • Ejection fraction-based categorization alone may not fully capture the spectrum of exercise limitations in heart failure patients.
  • CPET variables hold potential for refining the characterization of heart failure phenotypes.
Abstract

Keywords:
CPET profileCardiopulmonary exercise testingEjection fractionHeart failure

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