{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:37:29Z","timestamp":1792445849209,"version":"4.5.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Half of patients with heart failure with preserved ejection fraction (HFpEF) remain undiagnosed by resting evaluation alone. Therefore, exercise testing is proposed. The diastolic stress test (DST), however, has limited sensitivity. We aimed to determine the clinical significance of adding the mean pulmonary artery pressure over cardiac output (mPAP\/CO) slope to the DST in suspected HFpEF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In this prospective cohort study, consecutive patients (n=1936) with suspected HFpEF underwent exercise echocardiography with simultaneous respiratory gas analysis. These patients were stratified by exercise\n              <jats:italic>E<\/jats:italic>\n              over\n              <jats:italic>e<\/jats:italic>\n              \u2032 (exE\/\n              <jats:italic>e<\/jats:italic>\n              \u2032) and mPAP\/CO slope, and peak oxygen uptake, natriuretic peptides (NT\u2010proBNP [N\u2010terminal pro\u2010B\u2010type natriuretic peptide]), and score\u2010based HFpEF likelihood were compared. Twenty\u2010two percent of patients (n=428) had exE\/\n              <jats:italic>e<\/jats:italic>\n              \u2032&lt;15 despite a mPAP\/CO slope&gt;3\u2009mm\u2009Hg\/L per min, 24% (n=464) had a positive DST (exE\/\n              <jats:italic>e<\/jats:italic>\n              \u2032\u226515), and 54% (n=1044) had a normal DST and slope. Percentage of predicted oxygen uptake was similar in the group with exE\/\n              <jats:italic>e<\/jats:italic>\n              \u2032&lt;15 but high mPAP\/CO slope and the positive DST group (\u22122% [\u22125% to +1%]), yet worse than in those with normal DST and slope (\u221212% [\u221214% to \u22129%]). Patients with exE\/\n              <jats:italic>e<\/jats:italic>\n              \u2032&lt;15 but a high slope had NT\u2010proBNP levels and H\n              <jats:sub>2<\/jats:sub>\n              FPEF (heavy, hypertensive, atrial fibrillation, pulmonary hypertension, elder; filling pressure) scores intermediate to the positive DST group and the group with both a normal DST and slope.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Twenty\u2010two percent of patients with suspected HFpEF presented with a mPAP\/CO slope&gt;3\u2009mm\u2009Hg\/L per min despite a negative DST. These patients had HFpEF characteristics and a peak oxygen uptake as low as patients with a positive DST. Therefore, an elevated mPAP\/CO slope might indicate HFpEF irrespective of the DST result.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032228","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T10:52:26Z","timestamp":1721386346000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical Significance of Exercise Pulmonary Hypertension With a Negative Diastolic Stress Test for Suspected Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2697-0825","authenticated-orcid":false,"given":"Jan","family":"Verwerft","sequence":"first","affiliation":[{"name":"Jessa Hospital","place":["Hasselt, Belgium"]},{"name":"Biomedical Research Institute, Hasselt University","place":["Hasselt, 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Research Institute, Hasselt University","place":["Hasselt, Belgium"]},{"name":"University Hospital Brussels","place":["Jette, Belgium"]},{"name":"Vrije Universiteit Brussel","place":["Brussels, Belgium"]},{"name":"Ziekenhuis\u2010Oost Limburg","place":["Genk, Belgium"]},{"name":"KU Leuven","place":["Leuven, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5964-6058","authenticated-orcid":false,"given":"Sarah","family":"Hoedemakers","sequence":"additional","affiliation":[{"name":"Jessa Hospital","place":["Hasselt, Belgium"]},{"name":"Biomedical Research Institute, Hasselt University","place":["Hasselt, Belgium"]},{"name":"University Hospital Brussels","place":["Jette, Belgium"]},{"name":"Vrije Universiteit Brussel","place":["Brussels, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tin","family":"Gojevic","sequence":"additional","affiliation":[{"name":"Vrije Universiteit Brussel","place":["Brussels, 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