Heart failure & cardiomyopathiesSecondary analysis
Implications of Potential Undiagnosed Heart Failure with Preserved Ejection Fraction (HFpEF) on Symptomatic Response With Coronary Revascularization
- Secondary analysis of the ISCHEMIA randomised trial
- validation cohort with exercise right-sided heart catheterization
Authors' conclusion
More than one-half of patients with CAD and ischemia have dyspnea, with a high risk of undiagnosed HFpEF in one-tenth of these patients.
Study context
- Population
- ISCHEMIA participants without known heart failure (HF), with coronary artery disease (CAD) and a positive stress testvalidation cohort n = 237
- Participants
- 4,986 participants
- Comparison
- Invasive strategy vs conservative strategy, by probability of undiagnosed HFpEF
- Probable HFpEFn = 450
- Possible HFpEFn = 2,213
- Primary endpoint
- Prevalence of likely undiagnosed HFpEF and its interaction with an invasive strategy on QoL
Primary result
As reported in the abstract
Prevalence of dyspnea / HFpEF risk
- Dyspnea, at risk for HFpEF
- 53.4%
- Greater benefit in Probable HFpEF: SAQ Summary, Physical Limitation, Angina Frequency interaction P
- P = 0.01; P = 0.01; P = 0.08
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| HF hospitalization — Probable HFpEF vs No HFpEF | 7.2 (3.7–13.8) | P < 0.0001 | |
| HF hospitalization — Probable HFpEF vs Possible HFpEF | 5.0 (2.7–9.0) | P < 0.0001 | |
| HF hospitalization — Invasive strategy vs No HFpEF · invasive strategy did not mitigate risk in Probable HFpEF | 1.5 (0.7–3.5) | P = 0.34 | |
| 0.050.21520Hazard ratio (log scale) |
Baseline status, Probable HFpEF
- Worst exercise capacity, angina, dyspnea and quality of life (QoL) despite less obstructive CAD
- P < 0.0001 for all
Validation cohort (dyspnea and positive stress test)
- HFpEF
- 85%
- Elevated left-sided filling pressures at rest (of those with HFpEF)
- 68%
- n = 237
Original publication
Implications of Potential Undiagnosed HFpEF on Symptomatic Response With Coronary Revascularization. JACC Heart Fail. Published 13 January 2026. doi:10.1016/j.jchf.2025.102899
Summarised from the published abstract; every number is checked against it