Heart failure & cardiomyopathies
Exercise-Induced Out-Of-Proportion Increase in Afterload and Impaired Right Ventricular Contractile Reserve in Heart Failure with Preserved Ejection Fraction (HFpEF)
Authors' conclusion
Resting RV afterload elevation in HFpEF results in a compensatory increase in contractility. Out-of-proportion increase of afterload paralleled by inadequate increase in contractility results in failure to increase the cardiac index in HFpEF, potentially associated with exertional functional failure.
Study context
- Population
- Patients with exertional dyspnoea and diastolic dysfunction (E/e' > 8, left ventricular ejection fraction (LVEF) >50%) undergoing rest and exercise-stress echocardiography, right heart catheterization and cardiovascular magnetic resonance (CMR)
- Participants
- 34 vs 34
- Comparison
- HFpEF vs non-cardiac dyspnoea
- HFpEFn = 34
- Non-cardiac dyspnoea (NCD)n = 34reference
- Outcome
- CMR-derived RV loading conditions: afterload (Ea), contractility (Ees) and RV/pulmonary artery coupling (Ea/Ees)
- Follow-up
- Rest and exercise
Main finding
As reported in the abstract
| Group | Ea at rest | Ees at rest | Ea during exercise | Ees during exercise | Relative increase of contractility rest to stress |
|---|---|---|---|---|---|
| HFpEF | 1.20 | 0.61 | 2.48 | 1.00 | 1.56 |
| NCD | 0.85 | 0.37 | 1.53 | 0.74 | 1.97 |
Ea at rest
HFpEF1.20
NCD0.85
Ees at rest
HFpEF0.61
NCD0.37
Ea during exercise
HFpEF2.48
NCD1.53
Ees during exercise
HFpEF1.00
NCD0.74
Relative increase of contractility rest to stress
HFpEF1.56
NCD1.97
- HFpEF vs NCD: P = 0.001 — Ea at rest
- HFpEF vs NCD: P < 0.001 — Ees at rest
- HFpEF vs NCD: P < 0.001 — Ea and Ees during exercise
- HFpEF vs NCD: P = 0.022 — relative increase of contractility rest to stress
- Trend towards increased Ea/Ees from rest to stress in HFpEF
- P = 0.078
- Ea/Ees decreased from rest to stress in NCD
- P = 0.002
Further findings
Overt HFpEF vs Masked HFpEF
| Outcome | Overt HFpEF | Masked HFpEF | P value |
|---|---|---|---|
| Relative increase of contractility rest to stress, overt vs masked HFpEF (subgroup) | 1.40 | 1.86 | P = 0.001 |
Ea above median vs Ea below median
| Outcome | Ea below median | Ea above median | P value |
|---|---|---|---|
| Exercise-induced increase in cardiac index, by resting Ea above vs below median | 2.8 | 2.2 | P = 0.031 |
Ees above median vs Ees below median
| Outcome | Ees below median | Ees above median | P value |
|---|---|---|---|
| Exercise-induced increase in cardiac index, by resting Ees above vs below median | 2.9 | 2.1 | P < 0.001 |
Original publication
Exercise-Induced Out-Of-Proportion Increase in Afterload and Impaired Right Ventricular Contractile Reserve in HFpEF. ESC Heart Fail. Published 10 November 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →