. 2022 Jul 26;37(2):379–399. doi: 10.1007/s10557-022-07355-7

Table 4.

A summary of reported cardiovascular abnormalities in exercising HFpEF patients

Modality	Measurement found in HFpEF	Relevance	Refs.
Echocardiography	Mitral E/E’ > 15; increased right ventricular systolic pressure; tricuspid regurgitation velocity >3.4m/s	ExE measures correlate with invasively measured pulmonary capillary wedge pressure (PCWP) and form part of the ESC diagnostic criteria (HFA-PEFF score)	[18, 138]
	Mitral regurgitation; $↓$ left atrial strain augmentation	Indicative of right ventricular dysfunction and inefficient ventilation during exercise	[139]
Cardiac magnetic resonance imaging	$↓$ Diastolic filling rate; $↑$ left and right atrial volumes; $↓$ right ventricular ejection fraction augmentation during exercise; $↑$ lung proton density (water); $↓$ left atrial ejection fraction; $↓$ left atrial long axis strain; alterations in T₁ and ECV. Decreased PCr/ATP ratio.	Cardiac functional patterns linked to degree of impaired resting energetics (measured by the $^{31}$ P PCr to ATP ratio)	[116, 137]
Invasive haemodynamic measurements	PCWP $\geq$ 25.5 mmHg/W/kg; PCWP cardiac output slope >2 mmHg/l/m; supine PCWP $\geq$ 25 mmHg	Abnormally high exercise PCWP are confirmatory/diagnostic of HFpEF and have been associated with adverse cardiovascular outcomes	[140, 141]
Radionuclide ventriculography	$↑$ Time to peak filling; $↓$ $Δ$ left ventricular ejection fraction augmentation; $↑$ arterial to left ventricular end systolic elastance (vasculoventricular coupling)	In HFpEF during exercise, the active relaxation phase of diastole lengthens; shortens in controls	[72]
ECG	Chronotropic competence	Abnormal heart rate augmentation relates to degree of exercise intolerance	[142]
Cardiopulmonary exercise testing	$↓$ Peak VO $_{2}$ ; $↑$ VO $_{2}$ recovery kinetics; $↑$ VE/VCO $_{2}$ slope	Measures have been shown to predict cardiovascular outcomes among patients with HFpEF	[143, 144]

Abbreviations: HFA-PEFF, Heart Failure Association-PEFF with “P” standing for pre-test assessment, “E” echocardiography, “F” functional testing, and “F” final aetiology; PCWP, pulmonary capillary wedge pressure; VE/VCO $_{2}$ , ratio of minute ventilation to carbon dioxide elimination; VO $_{2}$ , oxygen uptake [145]