Key result
CPET blood pressure and chronotropic responses provide modest prognostic value for 3-year heart failure outcomes.
Why the study?
Abnormal blood pressure and heart rate responses during CPET are adverse prognostic indicators in HF, but the clinical significance of exercise-induced circulatory responses in patients with HFpEF remained unclear.
Do blood pressure and heart rate responses during cardiopulmonary exercise testing predict all-cause death and heart failure hospitalization in patients with heart failure stratified by ejection fraction?
Cohort (n=491)
Yes
Do blood pressure and heart rate responses during cardiopulmonary exercise testing predict all-cause death and heart failure hospitalization in patients with heart failure stratified by ejection fraction?
Although the overall prognostic performance of exercise-induced blood pressure (ΔSBP) and heart rate (CRI) responses during CPET is modest in heart failure patients, ΔSBP demonstrates relatively better predictive ability for adverse outcomes in the HFpEF subgroup.
Background Abnormal blood pressure and heart rate responses during cardiopulmonary exercise testing (CPET) have been reported as adverse prognostic indicators in patients with heart failure (HF). However, the clinical significance of exercise-induced circulatory responses in patients with HF with preserved ejection fraction (HFpEF) remains unclear. Purpose This study aimed to evaluate the associations of blood pressure and heart rate responses during CPET with adverse outcomes, stratified by left ventricular ejection fraction (LVEF). Methods In this multicenter retrospective cohort study conducted at 7 institutions in Japan, 491 patients with HF who underwent CPET were included. Patients were categorized into two groups according to LVEF: <50% [heart failure with reduced ejection fraction (HFrEF), n=286] and ≥50% (HFpEF, n=205). Blood pressure response was assessed using Δsystolic blood pressure (SBP), calculated as [Peak SBP - Rest SBP], and chronotropic response was evaluated using the chronotropic response index (CRI), calculated as [(peak heart rate - resting heart rate) / (220 - age - resting heart rate)]. The primary outcome was a composite of all-cause death and HF hospitalization within 3 years after CPET. We evaluated the prognostic ability of ΔSBP and CRI for all-cause mortality using the area under the curve (AUC) of the receiver operating characteristic curve. Results The primary outcome occurred in 91 of 491 patients (18.5%) in the overall cohort. In the HFrEF group (n=286), 66 events (23.1%) were observed, whereas 25 events (12.2%) occurred in the HFpEF group (n=205). In the overall cohort (n=491), the AUCs were 0.619 [95% confidence interval (CI): 0.557–0.681] for CRI and 0.609 (95% CI: 0.545–0.673) for ΔSBP. In the HFrEF group (n=286), the AUCs were 0.627 (95% CI: 0.551–0.703) for CRI and 0.575 (95% CI: 0.497–0.652) for ΔSBP. In the HFpEF group (n=205), the AUCs were 0.577 (95% CI: 0.458–0.696) for CRI and 0.649 (95% CI: 0.528–0.769) for ΔSBP, indicating relatively higher predictive ability of ΔSBP in HFpEF. Conclusion Although overall prognostic performance of both ΔSBP and CRI was modest, exercise-induced ΔSBP showed relatively better predictive ability in HFpEF, suggesting potential clinical relevance in this subgroup.ESC figure_mibe
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Mibe et al. (2026) conducted a cohort in Heart failure (n=491). Blood pressure response (ΔSBP) and chronotropic response index (CRI) during CPET vs. HFrEF (LVEF <50%) vs HFpEF (LVEF ≥50%) was evaluated on Composite of all-cause death and HF hospitalization within 3 years after CPET (AUC 0.619 (CRI); AUC 0.609 (ΔSBP), 95% CI 0.557-0.681). Exercise-induced ΔSBP and CRI during CPET showed modest prognostic performance for 3-year death or HF hospitalization (AUC 0.609 and 0.619), with ΔSBP performing best in HFpEF (AUC 0.649).
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