Heart failure & cardiomyopathiesCross-sectional study
Determinants of Submaximal Exercise Intolerance in Patients with Heart Failure and Preserved Ejection Fraction: Insights from the Lactate Threshold
- Cross-sectional study
- invasive haemodynamic cardiopulmonary exercise testing
Authors' conclusion
Two-thirds of patients with HFpEF reach LT at workloads typical of activities of daily living.
Study context
- Population
- Patients with heart failure with preserved ejection fraction (HFpEF) undergoing invasive haemodynamic cardiopulmonary exercise testing with blood lactate measurement
- Participants
- 286 patients
- Exposure
- Lactate threshold (LT) ≤40 W vs LT >40 W
- LT ≤40 Wn = 194
- LT >40 Wn = 92reference
- Outcome
- Lactate threshold (workload at which arterial lactate exceeded >2.0 mmol/L) as a measure of submaximal fitness
Main finding
As reported in the abstract
Workload at LT
- LT ≤40 W more likely female, anaemic, with greater pulmonary vascular disease vs LT >40 W
- P < 0.01
Observational data: associations, not effects.
Further findings
Haemodynamics, ventilation and symptoms during 20 W exercise
- LT ≤40 W: higher pulmonary artery pressure, biventricular filling pressures, minute ventilation, respiratory drive, dyspnoea and fatigue ratings, greater arterial-venous oxygen content difference, despite similar cardiac output and oxygen delivery
Peak exercise
- Most differences no longer apparent
Replication using non-invasive workload at ventilatory threshold
- Findings replicated
Original publication
Determinants of Submaximal Exercise Intolerance in Patients with Heart Failure and Preserved Ejection Fraction: Insights from the Lactate Threshold. Eur J Heart Fail. Published 18 June 2025. doi:10.1002/ejhf.3729
Summarised from the published abstract; every number is checked against it