Clinical Scorecard: Factors Influencing Exercise Capacity in Heart Failure with Preserved Ejection Fraction: The Roles of Central Hemodynamics, Ventilatory Efficiency, and Peripheral Muscle Oxygen Utilization and Function

At a Glance

Key Highlights

• Exercise intolerance is a hallmark feature of HFpEF, reflected by reduced peak oxygen uptake (V˙O2peak).
• Peripheral muscle function is more strongly associated with exercise capacity than central hemodynamics or ventilatory efficiency.
• Leg power and leg fat-free mass are significant predictors of relative and absolute V˙O2peak, respectively.
• Impaired peripheral oxygen extraction is a key determinant of reduced exercise tolerance in HFpEF.
• Skeletal muscle abnormalities, including reduced oxidative type I fibers, are associated with decreased V˙O2peak.

Guideline-Based Recommendations

Diagnosis

• Assessment of V˙O2peak and ventilatory efficiency through cardiopulmonary exercise testing.

Management

• Exercise training is recommended as part of clinical management for improving exercise capacity.

Monitoring & Follow-up

• Regular evaluation of muscle function and body composition to assess exercise capacity.

Risks

• Anemia and increased intermuscular fat infiltration may exacerbate exercise intolerance.

Patient & Prescribing Data

Older adults with HFpEF, often with obesity and cardiometabolic diseases.

Exercise training can improve exercise capacity despite the presence of multiple impairments.

Clinical Best Practices

• Consider both central and peripheral factors when evaluating exercise capacity in HFpEF.
• Incorporate assessments of muscle strength and composition in the management of HFpEF patients.
• Address anemia and body composition issues to improve exercise tolerance.

Related Resources & Content

• HIT-HF trial