{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T08:28:31Z","timestamp":1793348911941,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2011,12,1]],"date-time":"2011-12-01T00:00:00Z","timestamp":1322697600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Peak oxygen uptake (VO2) is diminished in patients with heart failure with preserved ejection fraction (HFpEF) suggesting impaired cardiac reserve. To test this hypothesis, we assessed the haemodynamic response to exercise in HFpEF patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Eleven HFpEF patients (73 \u00b1 7 years, 7 females\/4 males) and 13 healthy controls (70 \u00b1 4 years, 6 females\/7 males) were studied during submaximal and maximal exercise. The cardiac output (Qc, acetylene rebreathing) response to exercise was determined from linear regression of Qc and VO2 (Douglas bags) at rest, \u223c30% and \u223c60% of peak VO2, and maximal exercise. Peak VO2 was lower in HFpEF patients than in controls (13.7 \u00b1 3.4 vs. 21.6 \u00b1 3.6 mL\/kg\/min; P &amp;lt; 0.001), while indices of cardiac reserve were not statistically different: peak cardiac power output [CPO = Qc \u00d7 mean arterial pressure (MAP); HFpEF 1790 \u00b1 509 vs. controls 2119 \u00b1 581 L\/mmHg\/min; P = 0.20]; peak stroke work [SW = stroke volume (SV) \u00d7 MAP; HFpEF 13 429 \u00b1 2269 vs. controls 13 200 \u00b1 3610 mL\/mmHg; P = 0.80]. The \u0394Qc\/\u0394VO2 slope was abnormally elevated in HFpEF patients vs. controls (11.2 \u00b13.6 vs. 8.3 \u00b1 1.5; P = 0.015).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Contrary to our hypothesis, cardiac reserve is not significantly impaired in well-compensated outpatients with HFpEF. The abnormal haemodynamic response to exercise (decreased peak VO2, increased \u0394Qc\/\u0394VO2 slope) is similar to that observed in patients with mitochondrial myopathies, suggesting an element of impaired skeletal muscle oxidative metabolism. This impairment may limit functional capacity by two mechanisms: (i) premature skeletal muscle fatigue and (ii) metabolic signals to increase the cardiac output response to exercise which may be poorly tolerated by a left ventricle with impaired diastolic function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjhf\/hfr133","type":"journal-article","created":{"date-parts":[[2011,10,6]],"date-time":"2011-10-06T20:31:08Z","timestamp":1317933068000},"page":"1296-1304","source":"Crossref","is-referenced-by-count":215,"title":["Abnormal Haemodynamic Response to Exercise in Heart Failure with Preserved Ejection Fraction"],"prefix":"10.1093","volume":"13","author":[{"given":"Paul S.","family":"Bhella","sequence":"first","affiliation":[{"name":"John Peter Smith Health Network , Fort Worth, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Prasad","sequence":"additional","affiliation":[{"name":"The Institute for Exercise and Environmental Medicine , 7232 Greenville Ave, Suite 435, Dallas, TX, 75231 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Heinicke","sequence":"additional","affiliation":[{"name":"The Institute for Exercise and Environmental Medicine , 7232 Greenville Ave, Suite 435, Dallas, TX, 75231 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff L.","family":"Hastings","sequence":"additional","affiliation":[{"name":"The University of Texas-Southwestern Medical Center at Dallas , TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Arbab-Zadeh","sequence":"additional","affiliation":[{"name":"The Institute for Exercise and Environmental Medicine , 7232 Greenville Ave, Suite 435, Dallas, TX, 75231 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley","family":"Adams-Huet","sequence":"additional","affiliation":[{"name":"The University of Texas-Southwestern Medical Center at Dallas , TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric L.","family":"Pacini","sequence":"additional","affiliation":[{"name":"The Institute for Exercise and Environmental Medicine , 7232 Greenville Ave, Suite 435, Dallas, TX, 75231 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Shibata","sequence":"additional","affiliation":[{"name":"The University of Texas-Southwestern Medical Center at Dallas , TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Dean","family":"Palmer","sequence":"additional","affiliation":[{"name":"The Institute for Exercise and Environmental Medicine , 7232 Greenville Ave, Suite 435, Dallas, TX, 75231 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley R.","family":"Newcomer","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham , AL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Levine","sequence":"additional","affiliation":[{"name":"The University of Texas-Southwestern Medical Center at Dallas , TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,2,18]]},"reference":[{"key":"2026020203272955800_ejhfhfr133-bib-0001","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1161\/CIRCULATIONAHA.106.632745","article-title":"Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction","volume":"114","author":"Borlaug","year":"2006","journal-title":"Circulation"},{"key":"2026020203272955800_ejhfhfr133-bib-0002","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.jacc.2010.04.040","article-title":"Hemodynamic basis of exercise limitation in patients with heart failure and normal ejection fraction","volume":"56","author":"Maeder","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2026020203272955800_ejhfhfr133-bib-0003","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1056\/NEJMoa032566","article-title":"Diastolic heart failure\u2014abnormalities in active relaxation and passive stiffness of the left ventricle","volume":"350","author":"Zile","year":"2004","journal-title":"N Engl J Med"},{"key":"2026020203272955800_ejhfhfr133-bib-0004","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1161\/CIRCULATIONAHA.107.716886","article-title":"Role of left ventricular stiffness in heart failure with normal ejection fraction","volume":"117","author":"Westermann","year":"2008","journal-title":"Circulation"},{"key":"2026020203272955800_ejhfhfr133-bib-0005","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/eurjhf\/hfq168","article-title":"Tissue advanced glycation end products are associated with diastolic function and aerobic exercise capacity in diabetic heart failure patients","volume":"13","author":"Willemsen","year":"2011","journal-title":"Eur J Heart Fail"},{"key":"2026020203272955800_ejhfhfr133-bib-0006","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1161\/01.CIR.0000048123.22359.A0","article-title":"Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations","volume":"107","author":"Kawaguchi","year":"2003","journal-title":"Circulation"},{"key":"2026020203272955800_ejhfhfr133-bib-0007","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1001\/jama.288.17.2144","article-title":"Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure","volume":"288","author":"Kitzman","year":"2002","journal-title":"JAMA"},{"key":"2026020203272955800_ejhfhfr133-bib-0008","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1161\/01.CIR.83.3.778","article-title":"Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure","volume":"83","author":"Mancini","year":"1991","journal-title":"Circulation"},{"key":"2026020203272955800_ejhfhfr133-bib-0009","doi-asserted-by":"crossref","first-page":"3176","DOI":"10.1161\/01.CIR.94.12.3176","article-title":"Hemodynamic exercise testing: a valuable tool in the selection of cardiac transplantation candidates","volume":"94","author":"Chomsky","year":"1996","journal-title":"Circulation"},{"key":"2026020203272955800_ejhfhfr133-bib-0010","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.cardfail.2007.05.004","article-title":"Prognostic significance and measurement of exercise-derived hemodynamic variables in patients with heart failure","volume":"13","author":"Lang","year":"2007","journal-title":"J Card Fail"},{"key":"2026020203272955800_ejhfhfr133-bib-0011","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1172\/JCI115422","article-title":"Deficiency of skeletal muscle succinate dehydrogenase and aconitase. 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