Key result
Exercise CMR enables physiological stress assessment to guide HFpEF diagnosis, phenotyping, and treatment monitoring.
Why the study?
In HFpEF, functional abnormalities may emerge mainly during exercise, so resting investigations explain exertional symptoms only partly. Exercise cardiovascular magnetic resonance assesses cardiovascular reserve during physiological stress, prompting a review of its technical foundations and clinical applications in HFpEF.
This comprehensive review outlines the technical foundations and clinical evidence for using exercise cardiovascular magnetic resonance (Ex-CMR) to assess atrial, biventricular, and vascular reserve in the diagnosis, phenotyping, and treatment monitoring of HFpEF.
Ex-CMR may refine exertional phenotyping in HFpEF; leaves open standardization and clinical adoption pending prospective trials.
In heart failure with preserved ejection fraction (HFpEF), functional abnormalities may emerge mainly during exercise. Resting investigations may therefore explain exertional symptoms only partly. Exercise cardiovascular magnetic resonance (Ex-CMR) measures chamber volumes, deformation and blood flow during physiological stress to assess cardiovascular reserve. This review examines the technical foundations of Ex-CMR and its applications in HFpEF diagnosis, physiological phenotyping and treatment monitoring. It considers the physiological interpretation and clinical evidence for atrial, biventricular and vascular reserve indices, with attention to standardised acquisition, multiparametric assessment and clinical translation.
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Li et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Exercise cardiovascular magnetic resonance (Ex-CMR) was evaluated. Exercise cardiovascular magnetic resonance measures chamber volumes, deformation, and blood flow during physiological stress to support HFpEF diagnosis, phenotyping, and treatment monitoring.
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