Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Low peak oxygen uptake in relation to total heart volume as an early marker of subclinical diastolic dysfunction.

Steding Ehrenborg, Katarina LU ; Nelsson, Anders LU ; Engblom, Henrik LU ; Arvidsson, Per M LU ; Magnusson, Martin LU orcid ; Smith, J Gustav LU orcid and Arheden, Håkan LU (2025) In European Heart Journal Imaging Methods & Practice
Abstract
Aim
Peak oxygen uptake (VO2peak) is closely related to total heart volume (THV) in healthy individuals. This study aimed to investigate 1) the association between VO2peak and THV in subjects with subclinical diastolic dysfunction, athletes, healthy controls, and patients with established heart failure with and without preserved ejection fraction (HFpEF, HFrEF), and 2) whether VO2peak/THV-index can distinguish between subjects with subclinical diastolic dysfunction, HFpEF, HFrEF, and healthy controls.

Methods
Seventy participants were included: 15 with subclinical diastolic dysfunction (defined as showing only 1-2 echocardiographic signs of diastolic dysfunction, not meeting clinical diagnostic criteria), 10 athletes, 15... (More)
Aim
Peak oxygen uptake (VO2peak) is closely related to total heart volume (THV) in healthy individuals. This study aimed to investigate 1) the association between VO2peak and THV in subjects with subclinical diastolic dysfunction, athletes, healthy controls, and patients with established heart failure with and without preserved ejection fraction (HFpEF, HFrEF), and 2) whether VO2peak/THV-index can distinguish between subjects with subclinical diastolic dysfunction, HFpEF, HFrEF, and healthy controls.

Methods
Seventy participants were included: 15 with subclinical diastolic dysfunction (defined as showing only 1-2 echocardiographic signs of diastolic dysfunction, not meeting clinical diagnostic criteria), 10 athletes, 15 healthy controls and 30 heart failure patients (15 HFpEF, 15 HFrEF). VO2peak was assessed by cardiopulmonary exercise testing and THV by cardiovascular magnetic resonance imaging.

Results
In subclinical diastolic dysfunction, THV was a weak determinant of VO2peak (R2=0.41, p=0.01), and even weaker in heart failure (R2=0.16, p=0.03). However, THV strongly predicted VO2peak in athletes and controls combined (R2=0.87, p<0.0001). VO2peak/THV did not distinguish healthy controls from subclinical diastolic dysfunction but could reliably discriminate between healthy controls and patients with heart failure.

Conclusion
Subjects with subclinical diastolic dysfunction may have an altered relationship between VO2peak and total heart volume, approaching that of patients with established heart failure. Thus, this proof-of-concept study indicates that subclinical diastolic dysfunction constitutes a group of patients that may be of interest to follow over time to prevent continued deterioration of cardiac function. Furthermore, the VO2peak/THV ratio can be used to distinguish between healthy controls and overt heart failure. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
European Heart Journal Imaging Methods & Practice
publisher
Oxford University Press
ISSN
2755-9637
DOI
10.1093/ehjimp/qyaf115
language
English
LU publication?
yes
id
0514d3ef-502f-4a47-be66-211077a0ac40
date added to LUP
2025-09-15 16:12:43
date last changed
2025-09-17 03:11:18
@article{0514d3ef-502f-4a47-be66-211077a0ac40,
  abstract     = {{Aim<br/>Peak oxygen uptake (VO2peak) is closely related to total heart volume (THV) in healthy individuals. This study aimed to investigate 1) the association between VO2peak and THV in subjects with subclinical diastolic dysfunction, athletes, healthy controls, and patients with established heart failure with and without preserved ejection fraction (HFpEF, HFrEF), and 2) whether VO2peak/THV-index can distinguish between subjects with subclinical diastolic dysfunction, HFpEF, HFrEF, and healthy controls.<br/><br/>Methods<br/>Seventy participants were included: 15 with subclinical diastolic dysfunction (defined as showing only 1-2 echocardiographic signs of diastolic dysfunction, not meeting clinical diagnostic criteria), 10 athletes, 15 healthy controls and 30 heart failure patients (15 HFpEF, 15 HFrEF). VO2peak was assessed by cardiopulmonary exercise testing and THV by cardiovascular magnetic resonance imaging.<br/><br/>Results<br/>In subclinical diastolic dysfunction, THV was a weak determinant of VO2peak (R2=0.41, p=0.01), and even weaker in heart failure (R2=0.16, p=0.03). However, THV strongly predicted VO2peak in athletes and controls combined (R2=0.87, p&lt;0.0001). VO2peak/THV did not distinguish healthy controls from subclinical diastolic dysfunction but could reliably discriminate between healthy controls and patients with heart failure.<br/><br/>Conclusion<br/>Subjects with subclinical diastolic dysfunction may have an altered relationship between VO2peak and total heart volume, approaching that of patients with established heart failure. Thus, this proof-of-concept study indicates that subclinical diastolic dysfunction constitutes a group of patients that may be of interest to follow over time to prevent continued deterioration of cardiac function. Furthermore, the VO2peak/THV ratio can be used to distinguish between healthy controls and overt heart failure.}},
  author       = {{Steding Ehrenborg, Katarina and Nelsson, Anders and Engblom, Henrik and Arvidsson, Per M and Magnusson, Martin and Smith, J Gustav and Arheden, Håkan}},
  issn         = {{2755-9637}},
  language     = {{eng}},
  month        = {{09}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal Imaging Methods & Practice}},
  title        = {{Low peak oxygen uptake in relation to total heart volume as an early marker of subclinical diastolic dysfunction.}},
  url          = {{http://dx.doi.org/10.1093/ehjimp/qyaf115}},
  doi          = {{10.1093/ehjimp/qyaf115}},
  year         = {{2025}},
}