CPETecho for early diagnosis and deep phenotyping of HFpEF
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure, with limited therapeutic options and a poor prognosis. Challenges in HFpEF diagnosis, undifferentiated treatment of HFpEF patients despite phenotypical differences, and ignoring non-cardiac contribution to this multisystem disorder underly the unfavorable prognosis. Although exercise intolerance is the primary symptom among HFpEF patients, and current guidelines recommend exercise training, the responsible mechanisms remain unclear.
Combined echocardiography and cardiopulmonary exercise testing (CPETecho) is a non-invasive method that can characterize physiological limits to exercise, including in HFpEF patients. In this study, we aim to (1) evaluate whether routine use of CPETecho can improve the accuracy of HFpEF diagnosis, (2) identify subgroups of HFpEF patients with different exercise limitations (exercise phenotypes), and (3) characterize in detail a ‘muscle phenotype’ of HFpEF limited mostly by peripheral muscle oxygenation instead of cardiac limits.
We will recruit HFpEF patients from third-line hospitals and perform CPETecho, apply machine learning algorithms to define HFpEF phenotypes, and combine near-infrared-spectroscopy and muscle biopsies to assess peripheral oxygen extraction. Our study aims to address the clinical need for improved efficiency in HFpEF diagnosis and to identify HFpEF exercise phenotypes, contributing to the precision of HFpEF treatment.
Funding: FWO
Researcher: De Schutter Stephanie
Promotor: Gevaert Andreas
Co-promotor: Van de Heyning Caroline
Linking Skeletal Muscle Abnormalities to Exercise Limitations in HFpEF
Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure and is associated with exercise intolerance, lower quality of life, and recurrent hospitalizations. Current guidelines recommend exercise training for patients with heart failure, but do not specify which type of training is most effective. Exercise intolerance in HFpEF is increasingly recognized as the result of not only cardiac dysfunction, but also peripheral factors, including skeletal muscle abnormalities. This suggests that exercise approaches specifically targeting skeletal muscle may offer an important and currently underexplored therapeutic opportunity in HFpEF.
In this study, we investigate whether resistance training can improve physical performance and skeletal muscle abnormalities in patients with HFpEF. Specifically, we aim to: 1) determine the effect of a 12-week eccentric resistance training program on peak oxygen uptake (peak VO2), muscle strength, functional performance, and patient-reported outcomes in patients with HFpEF; 2) characterize structural and molecular skeletal muscle abnormalities in HFpEF through muscle biopsies; 3) evaluate whether eccentric resistance training can reverse these skeletal muscle abnormalities; and 4) assess and validate near-infrared spectroscopy (NIRS; Moxy Monitor), combined with cardiopulmonary exercise testing and echocardiography (CPETecho), as a non-invasive tool to measure muscle oxygenation and peripheral oxygen extraction during exercise.
Ultimately, this project strives to improve our understanding of exercise intolerance in HFpEF and support the development of more targeted strategies to improve exercise capacity and quality of life in these patients.
Funding: BOF
Researcher: Delvaeye Frauke
Promotor: Gevaert Andreas
Co-promotor: Van Craenenbroeck Emeline, Hens Wendy