An abbreviated exercise right heart catheterization protocol for the diagnosis of heart failure with preserved ejection fraction.

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) can only be confirmed invasively using exercise right heart catheterization (eRHC). Many centres do not perform eRHC as the current, well-established, eRHC protocol can be time consuming and costly. We sought to determine whether an abbreviated 3-minute exercise protocol could accurately diagnosis HFpEF. METHODS: We performed a retrospective analysis of all patients who underwent eRHC at the Alfred Hospital in Melbourne, Australia, between September 2008 and August 2025, comprised of a derivation cohort (n=518) and an independent internal validation cohort (n=255). We used receiver operating characteristic analysis to assess the diagnostic value of the 3-minute eRHC protocol as compared to the standard protocol of using peak exercise. Correlations between hemodynamic measurements at 3 minutes and peak exercise were assessed. RESULTS: =0.6348), between 3 minutes and peak exercise. The diagnostic capabilities of the abbreviated protocol were confirmed in the validation cohort, maintaining a high sensitivity (86%) and specificity (79%). CONCLUSIONS: An abbreviated 3-minute eRHC protocol has good diagnostic potential in HFpEF, with strong correlations in hemodynamics, when compared to peak exercise. Simplification of the current protocol to 3 minutes of exercise only could be a valid strategy to enable improved uptake and maximise resource utilisation, and reduce patient risk, while maintaining diagnostic accuracy.