Abstract
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 underutilization of exercise as part of therapy contribute to the unfavorable prognosis. Although exercise intolerance is a general symptom among HFpEF patients, and current guidelines recommend exercise training, the underlying pathophysiological mechanisms remain unclear. Recent research shows that 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) assess the impact of exercise training on these HFpEF exercise phenotypes. We will recruit HFpEF patients from 3 third-line hospitals and perform CPETecho. We will also analyze multicentre exercise training trials to assess the influence of exercise training on HFpEF exercise phenotypes. Our study will address the clinical need for better efficiency in HFpEF diagnosis. By defining HFpEF exercise phenotypes and evaluating the benefits of exercise training, we aim to improve the precision of HFpEF treatment.
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