Heart failure & cardiomyopathiesCohort study

Exercise cardiac magnetic resonance biventricular volumetric reserve in heart failure with preserved ejection fraction

Eur J Heart FailPublished

  • Retrospective analysis of a prospective observational multicentre study

Authors' conclusion

Ex-CMR-based assessment of LV/RV volumetric reserve reveals progressive biventricular dysfunction across HFpEF stages and supports biventricular volumetric reserve-based phenotyping for characterizing HFpEF pathophysiology.

Study context

Population
Heart failure with preserved ejection fraction (HFpEF) patients across early to advanced stages undergoing supine ergometer exercise CMR
Participants
140 patients
Exposure
HFpEF stages vs healthy controls and non-cardiac dyspnoea
  • Healthyn = 40reference
  • Non-cardiac dyspnoea (NCD)n = 27
  • HFpEFn = 73

Main finding

As reported in the abstract

Biventricular volumetric reserve on exercise CMR

All HFpEF subgroups: impaired LVEDV reserve and reduced LVEI

P < .0001

LVESV reserve impaired only in stage C

P < .0001

Exercise-induced RV dysfunction a hallmark of HFpEF with pulmonary hypertension

P < .0001

Biventricular efficiency index (EI) declined progressively with advancing HFpEF stage

P < .0001

Observational data: associations, not effects.

Further findings

Biventricular EI by NYHA class

Significantly lower in NYHA > II
P = 0.0006

Composite reserve phenotyping

Distinct reserve phenotypes
6

Original publication

Exercise cardiac magnetic resonance biventricular volumetric reserve in heart failure with preserved ejection fraction. Eur J Heart Fail. Published 16 April 2026. doi:10.1093/ejhf/xuag100

Summarised from the published abstract; every number is checked against it