Key result
Peak cardiac output by 3D echocardiography correlates moderately with peak-VO2 across heart failure phenotypes.
Why the study?
Three-dimensional echocardiography enables direct volumetric quantification of left ventricular stroke volume without geometric assumptions, but its capacity to assess cardiac output at peak exercise during simultaneous cardiopulmonary exercise testing had not been investigated.
Does three-dimensional echocardiographic assessment of peak cardiac output improve the prediction of peak oxygen uptake and functional capacity impairment compared to two-dimensional and Doppler methods in patients across the heart failure spectrum and controls?
Observational (n=126)
Does three-dimensional echocardiographic assessment of peak cardiac output improve the prediction of peak oxygen uptake and functional capacity impairment compared to two-dimensional and Doppler methods in patients across the heart failure spectrum and controls?
Volumetric assessment of peak cardiac output via 3-D echocardiography provides consistent phenotype-independent associations with peak oxygen uptake across the heart failure spectrum, outperforming Doppler-based methods particularly in HFpEF.
Answers are grounded in this paper and cite their sources.
Volumetric peak-CO supports consistent associations across HF phenotypes; leaves open whether 3-DE improves functional capacity prediction over Doppler in practice.
Background Peak oxygen uptake (peak-VO2) reflects the integrated cardiovascular performance and is primarily determined by maximal cardiac output. Three-dimensional echocardiography allows direct volumetric quantification of left ventricular stroke volume without geometric assumptions. However, its physiological capacity for assessing cardiac output at peak exercise (peak-CO) during simultaneous cardiopulmonary exercise test (CPET) has not been investigated. Purpose To evaluate the association between peak-VO2 and left ventricular peak-CO derived from three-dimensional echocardiography (3-DE), compared to the conventional two-dimensional echocardiography (2-DE) and Doppler-based methods, across heart failure phenotypes and controls. Methods We assessed 126 subjects (46 controls, 46 patients with heart failure with preserved ejection fraction [HFpEF], and 34 with reduced ejection fraction [HFrEF]) undergoing semi-supine cycle CPET imaging by echo. Peak-CO was calculated using 3-DE volumetric datasets, 2-DE methods, and Doppler-based measurements. Associations with peak-VO2 were evaluated overall and by phenotype using Pearson’s product–moment correlation. Multivariable linear regression analysis was performed. The ROC analysis was used for discriminating functional capacity impairment, defined as peak-VO2<18mL/kg/min, comparing peak-CO and other echocardiographic parameters potentially useful to determine functional disability. Results In the overall population, peak-CO correlated significantly with peak-VO2 using all three methodologies (3-DE: R = 0.54, 2-DE: R = 0.55, Doppler: R= 0.56; all p< 0.001), demonstrating positive independent associations after adjustment for age, sex, and BMI. Volumetric peak-CO (2-DE/3-DE) showed consistent associations across HF phenotypes, whereas Doppler-derived CO was significantly associated with peak-VO2 only in HFrEF, and not in controls or HFpEF. Moreover, peak-CO emerged as the strongest independent predictor for impaired functional capacity compared with other echocardiographic parameters. Conclusions Peak left ventricular cardiac output is a strong and independent determinant of exercise capacity across the heart failure spectrum and in controls. Volumetric assessment - particularly 3-DE - provides consistent phenotype-independent associations and appears especially informative in HFpEF, where Doppler-derived CO does not demonstrate a significant relationship, supporting the incremental value of three-dimensional quantification during CPET imaging.
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Maccallini et al. (2026) conducted an observational in Heart failure (HFpEF and HFrEF) and healthy controls (n=126). Three-dimensional echocardiography (3-DE) peak cardiac output assessment vs. Two-dimensional echocardiography (2-DE) and Doppler-based methods was evaluated on Association between peak cardiac output (peak-CO) and peak oxygen uptake (peak-VO2) (R = 0.54 (3-DE), R = 0.55 (2-DE), R = 0.56 (Doppler), p=<0.001). Peak cardiac output by 3D, 2D, and Doppler echocardiography correlated with peak-VO2 (R=0.54, 0.55, 0.56; all p<0.001), with 3D/2D showing consistent associations across HF phenotypes.
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