{"id":"46038","type":"article","url":"https://hartvaat.nl/2026/04/07/multi-orgaan-inspanningstekorten-kenmerken-de-aanleg-voor-hfpef/","title":"Multi-orgaan inspanningstekorten kenmerken de aanleg voor HFpEF","title_en":"Multiorgan Physiological Deficits During Exercise Identify Clinical and Molecular Predisposition to Heart Failure With Preserved Ejection Fraction","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077579","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077579","authors":["Isabela Landsteiner"],"significance":7,"published":"2026-07-16","source_date":"2026-04-07","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/invasieve-hemodynamiek-rechts-hartkatheterisatie/","https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"Exercise unmasks the limited multi-organ reserve characteristic of heart failure with preserved ejection fraction (HFpEF). Using invasive cardiopulmonary exercise testing (iCPET), metabolite profiling and genomics, the investigators characterised seven exercise physiologic deficits in HFpEF patients: reduced exercise stroke volume and heart rate, a steep PCWP/cardiac-output slope, elevated pulmonary vascular resistance, pulmonary mechanical limitation, impaired peripheral oxygen extraction, and the obesity-related exaggerated metabolic cost of exercise. They mapped the distribution and the functional and prognostic significance of these deficits and linked them to molecular (metabolite and genetic) signatures — a step toward more targeted HFpEF phenotyping and risk assessment.","created":"2026-07-03T20:27:09Z","updated":"2026-07-04T19:26:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Inspanning legt de beperkte reservecapaciteit van meerdere orgaansystemen bloot die kenmerkend is voor hartfalen met behouden ejectiefractie (HFpEF). Met invasieve cardiopulmonale inspanningstests (iCPET), metabolietprofielen en genomica karakteriseerden de onderzoekers bij HFpEF-patiënten zeven fysiologische inspanningstekorten: een verlaagd inspanningsslagvolume en een lagere hartfrequentie, een steile PCWP/cardiac-output-curve, verhoogde pulmonale vaatweerstand, pulmonale mechanische beperking, verminderde perifere zuurstofextractie en de obesitasgerelateerde verhoogde metabole kost van inspanning. Ze brachten de verdeling en de functionele en prognostische betekenis van deze tekorten in kaart en koppelden ze aan moleculaire (metaboliet- en genetische) signaturen — een stap richting gerichtere fenotypering en risicobepaling bij HFpEF.","abstract_original":"Background: Exercise unmasks limitations in multi-organ system reserve capacity characteristic of heart failure with preserved ejection fraction (HFpEF). However, the metabolic and genetic underpinnings of exercise deficits, and their cumulative contribution to HFpEF severity and prognosis, remain incompletely understood.Methods: We used invasive cardiopulmonary exercise testing (iCPET), metabolite profiling, and genomics to simultaneously characterize seven exercise physiologic deficits in HFpEF patients: reduced exercise stroke volume and heart rate, steep pulmonary capillary wedge pressure/cardiac output (PCWP/CO) slope, elevated pulmonary vascular resistance, pulmonary mechanical limitation to exercise, impaired peripheral oxygen extraction, and obesity-related exaggerated metabolic cost of initiating exercise. We first mapped the distribution, functional, and prognostic significance of these exercise deficits. We then applied LASSO regression to identify metabolite signatures of e"}