Potential of cardiopulmonary exercise testing and diastolic stress test in diagnosis of heart failure with preserved ejection fraction in patients with hypertension and obesity

Aim. To evaluate the potential of cardiopulmonary exercise testing in combination with exercise stress echocardiography in detection of heart failure (HF) with preserved ejection fraction (HFpEF) in patients with hypertension (HTN) and obesity.

Material and methods. The observational study included 150 patients with HTN, of which 35 were without obesity and had no signs of HF, 35 — with obesity and without signs of HF, while 80 had signs of HFpEF and obesity. Hypertension was considered detected with office blood pressure ≥140/90 mm Hg, while obesity — with a body mass index ≥30 kg/m². Patients underwent resting and exercise echocardiography, and the parameters of systolic and diastolic left ventricular (LV) function were analyzed. During the diastolic stress test, LV diastolic function was assessed at 50 W, upon reaching the anaerobic threshold (AT), submaximal heart rate, and during the recovery period.

Results. The mean age of patients was 58,2±10,8 years. Changes of tissue Doppler parameters in patients with HFpEF showed significantly lower septal and lateral mitral annulus velocity (e’) at all exercise stages, compared with other groups. At the same time, septal and lateral e' increased as AT was reached, and a further exercise increase was not accompanied by an increase in these parameters at the level of submaximal heart rate.

Conclusion. The combination of diastolic stress test with cardiopulmonary testing made it possible to identify a decrease in LV systolic function with a load increase above AT in patients with HFpEF, while in other groups these parameters continued to grow. These parameters can be used in the diagnosis of HFpEF with an inconclusive increase in the ratio of the peak velocity of early diastolic transmitral flow to early diastolic rise of LV base (E/e’) at a low exercise level.

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