{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:06:59Z","timestamp":1789556819783,"version":"build-2803163510"},"reference-count":19,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"unspecified","delay-in-days":49,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018890","name":"Dutch Cardiovascular Alliance","doi-asserted-by":"publisher","award":["2020B008 RECONNEXT"],"award-info":[{"award-number":["2020B008 RECONNEXT"]}],"id":[{"id":"10.13039\/100018890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diagnosing heart failure with preserved ejection fraction (HFpEF) can be challenging because natriuretic peptide (NP) plasma levels and diastolic function parameters during rest echocardiography may be normal or marginally abnormal in patients displaying exercise-induced symptoms suggestive of HF. In these patients exercise echocardiography is recommended.<\/jats:p>\n                    <jats:p>We wanted to assess whether directly measured NP levels post-exercise had added diagnostic value beyond rest plasma N-terminal pro-brain NP (NT-proBNP) levels for diagnosing HFpEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants with left ventricular diastolic dysfunction (LVDD), who could not be classified as HFpEF by a panel of experts more than 4 years ago, were prospectively enrolled in the HELPFulUP observational study from August 2021 to October 2022. All participants in the HELPFulUP study underwent clinical assessment, rest and exercise-echocardiography and measurements of plasma NT-proBNP before and directly after exercise. An expert panel, blinded to exercise NT-proBNP results, but with knowledge of signs, symptoms and all other diagnostic parameters including baseline values of NT-proBNP adjudicated HFpEF status. We calculated the area under the receiver operating characteristic curve (area under the curve (AUC)) for HFpEF for rest and post-exercise NT-proBNP levels and the delta NT-proBNP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 112 LVDD participants (59\u2009women), 11 were diagnosed with HFpEF by the expert panel based on the additional information retrieved from exercise echocardiography, and 101 remained classified as LVDD. Rest (AUC=0.78 (95% CI 0.66 to 0.90)\u2009and exercise values of NT-proBNP (AUC=0.77 (95% CI 0.65 to 0.90) had similar discriminatory value. The delta NT-proBNP AUC was 0.53 (95% CI 0.31 to 0.75).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this pilot study, the diagnostic performance of the change with exercise in NP levels to detect incident HFpEF, beyond measurements in rest, did not point to a strong diagnostic value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004313","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:20:16Z","timestamp":1787149216000},"page":"e004313","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Natriuretic peptide responses to exercise in HFpEF diagnosis: a pilot study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1249-0767","authenticated-orcid":false,"given":"Anne Margje Lisa Naomi","family":"van Ommen","sequence":"first","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8999-9946","authenticated-orcid":false,"given":"Elisa","family":"Dal Canto","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands"},{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten Jan","family":"Cramer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2360-913X","authenticated-orcid":false,"given":"N. Charlotte","family":"Onland-Moret","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Taha","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arco J.","family":"Teske","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Menken","sequence":"additional","affiliation":[{"name":"Cardiology Centers of the Netherlands, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester M.","family":"den Ruijter","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans H.","family":"Rutten","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026091603501834000_13.2.e004313.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"2026091603501834000_13.2.e004313.2","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/S0140-6736(23)02756-3","article-title":"Heart failure with preserved ejection fraction: everything the clinician needs to know","volume":"403","author":"Campbell","year":"2024","journal-title":"The Lancet"},{"key":"2026091603501834000_13.2.e004313.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz641"},{"key":"2026091603501834000_13.2.e004313.4","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-016-0817-7"},{"key":"2026091603501834000_13.2.e004313.5","doi-asserted-by":"crossref","first-page":"5068","DOI":"10.1002\/ehf2.13575","article-title":"Exercise-induced B-lines in heart failure with preserved ejection fraction occur along with diastolic function worsening","volume":"8","author":"Simonovic","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026091603501834000_13.2.e004313.6","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1002\/ejhf.1228","article-title":"Exercise elicits dynamic changes in extravascular lung water and haemodynamic congestion in heart failure patients with preserved ejection fraction","volume":"20","author":"Simonovic","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2026091603501834000_13.2.e004313.7","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.119.006769","article-title":"Prognostic Value of Dynamic Changes in Pulmonary Congestion During Exercise Stress Echocardiography in Heart Failure With Preserved Ejection Fraction","volume":"13","author":"Coiro","year":"2020","journal-title":"Circ Heart Fail"},{"key":"2026091603501834000_13.2.e004313.8","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1002\/ehf2.12375","article-title":"Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study","volume":"6","author":"Belyavskiy","year":"2019","journal-title":"ESC Heart Fail"},{"key":"2026091603501834000_13.2.e004313.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-028408","article-title":"Discovery of biomarkers for the presence and progression of left ventricular diastolic dysfunction and HEart faiLure with Preserved ejection Fraction in patients at risk for cardiovascular disease: rationale and design of the HELPFul case-cohort study in a Dutch cardiology outpatient clinic","volume":"9","author":"Valstar","year":"2019","journal-title":"BMJ Open"},{"key":"2026091603501834000_13.2.e004313.10","doi-asserted-by":"crossref","unstructured":"Riley RD , Ensor J , Snell KIE , et al . 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