Abstract
Heart Failure with preserved Ejection Fraction (HFpEF) is a complex syndrome with a rising prevalence due to the aging population and a reserved prognosis. Early pathological changes may not be noticeable at rest but can be identified through exercise stress testing. The combination of CPET and exercise stress echocardiography (ESE) could provide important insights for early diagnosis and risk stratification. Sixty-six patients with chronic exertional dyspnea and suspected HFpEF were included in the study. They underwent symptom-limited combined CPET with ESE and were monitored for cardiac decompensation for 12 to 18 months. Twenty-six patients (39% of the cohort) experienced cardiac decompensation during this period. Several resting and ESE parameters, along with most CPET parameters, demonstrated predictive value, for identifying cardiac decompensations in the studied population, as determined by linear regression analysis. Due to the high number of predictors and their correlations, Lasso regression was applied to address multicollinearity. After Lasso analysis, only three parameters remained significantly associated with cardiac decompensation: exercise E/e' ratio, exercise left atrial (LA) strain, and maximum work rate. The model, including all three key predictors, achieved 87.87% accuracy, 63.63% sensitivity, and 100% specificity. ESE is a useful tool in evaluating prognosis and risk stratification of patients with chronic exertional dyspnea and suspected HFpEF. The addition of the novel parameter, exercise LA strain, enhanced the predictive value of the classic echocardiographic parameter, E/e’ ratio at effort. Although CPET parameters showed some predictive potential, the added benefit of incorporating CPET remains limited in the early stages of HFpEF.
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