{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:02:25Z","timestamp":1788393745975,"version":"build-2803163510"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":405,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Bourse 2017 of the French Society of Cardiology"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unexplained exertional dyspnoea without significant elevation of natriuretic peptides is common. One of the causes might be early heart failure with preserved ejection fraction (HFpEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to characterize patients with exertional dyspnoea and normal\/near-to-normal N-terminal pro-brain natriuretic peptide (NT-proBNP) levels with regard to early stages of HFpEF and non-cardiac causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method and Results<\/jats:title>\n                    <jats:p>Sixty-six patients (age 62 \u00b1 7 years old, 85% women) with dyspnoea assessed using the Multidimensional Dyspnea Profile (MDP) questionnaire and NT-proBNP level of &amp;lt;125 pg\/mL for patients &amp;lt;75 years old or &amp;lt;300 pg\/mL for patients &amp;gt;75 years old were recruited. Patients with known significant heart disease, lung disease (abnormal respiratory function tests) or renal insufficiency stage \u2265 4 were excluded. In 11 patients (16.7%), HFpEF was confirmed according to the European Society of Cardiology Heart Failure Association (ESC HFA) criteria, 31 patients (47%) presented isolated deconditioning and 5 patients (7.6%) had idiopathic hyperventilation. In the remaining 19 patients (28.8%) with normal echocardiography and cardiopulmonary exercise testing (CPX), no objective cause of dyspnoea could be found. Compared with patients without HFpEF, those with HFpEF were older, more often hypertensive and diabetic, with higher NT-proBNP levels. They had higher E\/e\u2032 ratios during exercise echocardiography and lower volume of oxygen uptake (VO2) peaks and steeper minute ventilation (VE)\/volume of carbon dioxide produced (VCO2) slopes during CPX. Psychological impact measured on the Short Form-36 (SF-36) questionnaire was less important in HFpEF patients than in other patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The most common causes of unexplained exertional dyspnoea in patients without significant elevation of natriuretic peptides are peripheral deconditioning, HFpEF and hyperventilation. Studying patients during exercise allows for getting more data about pathophysiology and improving patient phenotyping and management. Early unmasking of HFpEF using exercise echocardiography and\/or CPX and initiation of treatment could prevent hospitalizations for acute heart failure. Although using exercise testing, many patients could not be classified according to their diagnosis, and this reinforces the need to better define exercise diagnostic criteria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15059","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T05:27:07Z","timestamp":1736400427000},"page":"879-887","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comprehensive Exploration of Unexplained Dyspnoea in Subjects with Normal Ejection Fraction and Low Natriuretic Peptides"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-3110","authenticated-orcid":false,"given":"Emmanuelle","family":"Berthelot","sequence":"first","affiliation":[{"name":"AP-HP, Department of Cardiology, Bic\u00eatre Hospital , Le Kremlin-Bic\u00eatre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Laouar","sequence":"additional","affiliation":[{"name":"AP-HP, Department of Cardiology, Bic\u00eatre Hospital , Le Kremlin-Bic\u00eatre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Beurnier","sequence":"additional","affiliation":[{"name":"AP-HP, Departement of Physiology \u2013 Functional Explorations, DMU 5 Thorinno, bi-site Bic\u00eatre (Le Kremlin Bic\u00eatre) and Ambroise Par\u00e9 (Boulogne-Billancourt) Hospitals , Le Kremlin-Bic\u00eatre ,","place":["France"]},{"name":"Universit\u00e9 Paris-Saclay, INSERM, UMR_S 999, Hypertension Pulmonaire: Physiopathologie and Innovation Th\u00e9rapeutique (HPPIT), AP-HP, H\u00f4pital Bic\u00eatre, H\u00f4pital Marie Lannelongue (Groupe Hospitalier Paris Saint Joseph), ERN-LUNG , Le Kremlin-Bic\u00eatre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nataliya","family":"Hrynchynshyn","sequence":"additional","affiliation":[{"name":"AP-HP, Department of Cardiology, Bic\u00eatre Hospital , Le Kremlin-Bic\u00eatre ,","place":["France"]},{"name":"Universit\u00e9 Paris-Saclay, INSERM, UMR_S 999, Hypertension Pulmonaire: Physiopathologie and Innovation Th\u00e9rapeutique (HPPIT), AP-HP, H\u00f4pital Bic\u00eatre, H\u00f4pital Marie Lannelongue (Groupe Hospitalier Paris Saint Joseph), ERN-LUNG , Le Kremlin-Bic\u00eatre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Christophe","family":"Eicher","sequence":"additional","affiliation":[{"name":"CHU de Dijon, H\u00f4pital Fran\u00e7ois Mitterrand , Dijon ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Tarti\u00e8re","sequence":"additional","affiliation":[{"name":"Sainte Musse Hospital, Department of Cardiology and Direction de la Recherche Clinique et de l'Innovation, CHITS , Toulon, Var ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Jourdain","sequence":"additional","affiliation":[{"name":"AP-HP, Department of Cardiology, Bic\u00eatre Hospital , Le Kremlin-Bic\u00eatre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Lairez","sequence":"additional","affiliation":[{"name":"Toulouse 3 \u2013 Paul Sabatier University, University Hospital, Department of cardiology , Toulouse Cedex 9 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barnabas","family":"Gellen","sequence":"additional","affiliation":[{"name":"ELSAN Poitiers Private Hospital , Poitiers ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"2026021804024319200_ehf215059-bib-0001","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1002\/ejhf.1858","article-title":"Epidemiology of heart failure","volume":"22","author":"Groenewegen","year":"2020","journal-title":"Eur J Heart Fail ao\u00fbt"},{"key":"2026021804024319200_ehf215059-bib-0002","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1161\/CIRCRESAHA.119.313572","article-title":"Heart failure with preserved ejection fraction in perspective","volume":"124","author":"Pfeffer","year":"2019","journal-title":"Circ Res"},{"key":"2026021804024319200_ehf215059-bib-0003","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1002\/ejhf.483","article-title":"Epidemiology of heart failure: The prevalence of heart failure and ventricular dysfunction in older adults over time. 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