{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:32:02Z","timestamp":1792801922744,"version":"4.5.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100006084","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 HL158077"],"award-info":[{"award-number":["R01 HL158077"]}],"id":[{"id":"10.13039\/100006084","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a syndrome of reserve dysfunction. However, integrated assessment of biventricular (LV\/RV) volumetric reserve under physiological stress remains underexplored. We aimed to investigate whether exercise cardiac magnetic resonance (Ex-CMR) can reveal distinct volumetric reserve profiles across the HFpEF spectrum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective analysis of a prospective observational, multicentre study, supine ergometer Ex-CMR was performed in HFpEF patients across early to advanced stages (stage B, exercise-induced, stage C), along with healthy controls and a non-cardiac dyspnoea (NCD) group. Percentage changes in LV\/RV end-diastolic (\u0394EDV%) and end-systolic volumes (\u0394ESV%) from rest to stress defined EDV reserve and ESV reserve, respectively. Ventricular efficiency index (EI) was defined as \u0394EDV%\u2014\u0394ESV%; biventricular EI as LVEI + RVEI. Group comparisons were performed using ANOVA and post hoc testing. Multivariable general linear model analyses adjusted for age, sex, BMI, and exercise response. A composite phenotyping assessment incorporating all four key reserve parameters was explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 140 participants (40 healthy, 27 NCD, and 73 HFpEF), all HFpEF subgroups showed impaired LVEDV reserve and reduced LVEI (P &amp;lt; .0001). LVESV reserve was impaired only in stage C (P &amp;lt; .0001). Exercise-induced RV dysfunction was a hallmark of HFpEF with pulmonary hypertension (P &amp;lt; .0001). Biventricular EI declined progressively with advancing HFpEF stage (P &amp;lt; .0001) and was significantly lower in NYHA &amp;gt; II (P = .0006). Six distinct reserve phenotypes emerged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ex-CMR\u2013based assessment of LV\/RV volumetric reserve reveals progressive biventricular dysfunction across HFpEF stages and supports biventricular volumetric reserve\u2013based phenotyping for characterizing HFpEF pathophysiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Question<\/jats:title>\n                    <jats:p>Can the integration of left and right ventricular end-diastolic and end-systolic volume reserve under physiological stress reveal distinct profiles across the HFpEF spectrum and enhance our understanding of its haemodynamic heterogeneity?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Findings<\/jats:title>\n                    <jats:p>Non-invasive assessment of biventricular volumetric reserve, along with their intra- and interventricular interactions using exercise CMR, revealed a significant, stepwise deterioration across HFpEF subgroups, worsening with NYHA class &amp;gt; II. Exercise CMR enabled composite volumetric reserve\u2013based phenotyping and identified six distinct reserve phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Take Home Message<\/jats:title>\n                    <jats:p>Biventricular volumetric reserve assessment is feasible through exercise CMR and may support future precision therapy strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag100","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T11:31:19Z","timestamp":1776166279000},"source":"Crossref","is-referenced-by-count":3,"title":["Exercise cardiac magnetic resonance biventricular volumetric reserve in heart failure with preserved ejection fraction"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4062-4550","authenticated-orcid":false,"given":"Fahime","family":"Ghanbari","sequence":"first","affiliation":[{"name":"Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School , 330 Brookline Ave, Boston, MA 02215 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa M","family":"Gopal","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long H","family":"Ngo","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School , 330 Brookline Ave, Boston, MA 02215 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School , 330 Brookline Ave, Boston, MA 02215 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron B","family":"Waxman","sequence":"additional","affiliation":[{"name":"Department of Medicine (Division of Pulmonary and Critical Care), Brigham and Women's Hospital and Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren J","family":"Manning","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School , 330 Brookline Ave, Boston, MA 02215 ,","place":["USA"]},{"name":"Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Nezafat","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and 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