Key result
Higher coronary flow reserve is independently linked to better exercise capacity in suspected HFpEF.
Why the study?
Exercise intolerance in heart failure involves heterogeneous mechanisms including coronary microvascular dysfunction, obesity, and sarcopenia, but their relationships with exercise capacity in suspected HFpEF are not fully understood.
Does coronary microvascular function and body composition correlate with cardiopulmonary exercise capacity in patients with suspected HFpEF?
Cross-Sectional (n=101)
No
Does coronary microvascular function and body composition correlate with cardiopulmonary exercise capacity in patients with suspected HFpEF?
Effect estimate: r=0.344
p-value: p=<0.001
In patients with suspected HFpEF, cardiopulmonary exercise capacity is independently associated with coronary microvascular function and body fat, highlighting the multifactorial nature of exercise intolerance.
Should not yet change practice in suspected HFpEF; hypothesis-generating for microvascular and adiposity-targeted interventions.
Background: Exercise intolerance in heart failure reflects heterogeneous mechanisms, including coronary microvascular dysfunction (CMD), obesity and sarcopenia. The aim of this study was to investigate the relationships between cardiopulmonary exercise capacity, coronary microvascular function and body composition in patients with suspected heart failure with preserved ejection fraction (HFpEF). Methods: In this single-centre cross-sectional study, consecutive patients presenting with chest discomfort or dyspnoea and an intermediate or high probability of HFpEF were enrolled. All patients underwent body composition analysis, adenosine stress echocardiography for coronary flow reserve (CFR) and cardiopulmonary exercise testing to assess peak oxygen consumption (VO2peak). Results: Of the 101 patients (mean age 63 years; 52.0% women), CMD (CFR <2.5) was present in 40.6%. Mean VO2peak was 23.0 ± 5.3 ml/min/kg. Patients with lower VO2peak (<23 ml/min/kg) had higher visceral fat area and percentage body fat. VO2peak correlated positively with CFR (r=0.344, p<0.001) and septal e′ velocity and inversely with E/e′. Skeletal muscle mass index correlated positively with VO2peak predominantly in obese patients (BMI ≥25 kg/m2). In multivariable analysis, both CFR and degree of body fat remained independent correlates of VO2peak. Conclusion: In patients with suspected HFpEF, cardiopulmonary exercise capacity is closely associated with left ventricular diastolic function, coronary microvascular function and body composition. Preserved skeletal muscle mass may mitigate the adverse impact of obesity on exercise performance. These findings highlight the importance of integrated assessment of CMD and body composition and support targeted lifestyle and exercise interventions to improve functional capacity in HFpEF phenotypes.
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Kim et al. (2026) conducted a cross-sectional in Suspected heart failure with preserved ejection fraction (HFpEF) (n=101). Coronary microvascular function and body composition vs. Normal coronary microvascular function and body composition was evaluated on Peak oxygen consumption (VO2peak) (r=0.344, p=<0.001). In patients with suspected HFpEF, cardiopulmonary exercise capacity (VO2peak) was independently and positively correlated with coronary flow reserve (r=0.344) and inversely correlated with percentage body fat.
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