Heart failure & cardiomyopathies
Exercise stress echocardiography for diagnosis of heart failure with preserved ejection fraction: a multicentre study
Authors' conclusion
Currently used non-invasive approaches to HFpEF diagnosis have inadequate sensitivity, indicating that exercise echocardiography cannot supplant invasive testing. Addition of LA strain imaging with optimized rule-in or rule-out values improves diagnostic triage by expanding non-invasive rule-in/rule-out classifications while identifying patients who still require invasive testing in the evaluation of HFpEF.
Study context
- Population
- Patients with chronic unexplained dyspnoeaHeart failure with preserved ejection fraction (HFpEF) 386, non-cardiac dyspnoea 96
- Participants
- 482 patients
- Comparison
- Diagnostic scores with exercise echocardiography, with or without resting left atrial (LA) compliance, vs invasive exercise testing
- Outcome
- Diagnostic performance for HFpEF against invasive haemodynamic exercise testing
Methodological detailsinvasive haemodynamic exercise testing with simultaneous echocardiography, international multicentre validation cohort
- Invasive haemodynamic exercise testing with simultaneous echocardiography
- International multicentre validation cohort
Performance
As reported in the abstract
Detection of HFpEF
| Test or model | Sensitivity | Accuracy | False-positive rate | Sensitivity (definitively classified patients) | Patients requiring invasive exercise testing |
|---|---|---|---|---|---|
| Scores + exercise echocardiography | 55%-60% | 61%-67% | |||
| + abnormal resting LA compliance | 84%-85% | 31%-43% | |||
| Separate cut points | 95%-99% | ∼30% |
Sensitivity
Scores + exercise echocardiography55%-60%
+ abnormal resting LA compliance84%-85%
Separate cut pointsNot reported in the abstract
Accuracy
Scores + exercise echocardiography61%-67%
+ abnormal resting LA complianceNot reported in the abstract
Separate cut pointsNot reported in the abstract
False-positive rate
Scores + exercise echocardiographyNot reported in the abstract
+ abnormal resting LA compliance31%-43%
Separate cut pointsNot reported in the abstract
Sensitivity (definitively classified patients)
Scores + exercise echocardiographyNot reported in the abstract
+ abnormal resting LA complianceNot reported in the abstract
Separate cut points95%-99%
Patients requiring invasive exercise testing
Scores + exercise echocardiographyNot reported in the abstract
+ abnormal resting LA complianceNot reported in the abstract
Separate cut points∼30%
Further findings
Validation cohort
- Findings replicated in a multicentre, international validation cohort
Original publication
Exercise stress echocardiography for diagnosis of heart failure with preserved ejection fraction: a multicentre study. Eur Heart J. Published 10 September 2026. doi:10.
Summarised from the published abstract; every number is checked against it