{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:05:07Z","timestamp":1792512307683,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T00:00:00Z","timestamp":1717632000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardiopulmonary exercise testing (CPET) combined with exercise echocardiography (CPETecho) allows simultaneous assessments of cardiac, pulmonary, and ventilation in heart failure (HF) with preserved ejection fraction (HFpEF). This study sought to determine whether simultaneous assessment of CPET variables could provide additive predictive value over exercise stress echocardiography in patients with dyspnoea.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      CPETecho was performed in 443 patients with suspected HFpEF (240 HFpEF and 203 controls without HF). Patients with HFpEF were divided based on peak oxygen consumption (VO\n                      <jats:sub>2<\/jats:sub>\n                      , \u226510 or\u2009&lt;10\u2009ml\/min\/kg) or the slope of minute ventilation to carbon dioxide production (V\n                      <jats:sub>E<\/jats:sub>\n                      vs. VCO\n                      <jats:sub>2<\/jats:sub>\n                      slope \u226545.0 or\u2009&lt;45.0). The primary endpoint was defined as a composite of all\u2010cause mortality, HF hospitalization, unplanned hospital visits requiring intravenous diuretics, or intensification of oral diuretics. During a median follow\u2010up of 399\u2009days, the composite outcome occurred in 57 patients. E\/e' ratio during peak exercise was associated with adverse outcomes. Patients with HFpEF and lower peak VO\n                      <jats:sub>2<\/jats:sub>\n                      had increased risks of the composite event (hazard ratio [HR] 5.05, 95% confidence interval [CI] 2.65\u20139.62,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001 vs. controls; HR 3.14, 95% CI 1.69\u20135.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003 vs. HFpEF with higher peak VO\n                      <jats:sub>2<\/jats:sub>\n                      ). Elevated V\n                      <jats:sub>E<\/jats:sub>\n                      versus VCO\n                      <jats:sub>2<\/jats:sub>\n                      slope was also associated with adverse events in HFpEF. The addition of either the presence of abnormal peak VO\n                      <jats:sub>2<\/jats:sub>\n                      or V\n                      <jats:sub>E<\/jats:sub>\n                      versus VCO\n                      <jats:sub>2<\/jats:sub>\n                      slope increased the predictive ability over the model based on age, sex, atrial fibrillation, left atrial volume index, and exercise E\/e' (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These data provide new insights into the role of CPETecho in patients with HFpEF.<\/jats:p>\n                  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