Research Stephanie De Schutter

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure, with limited therapeutic options and a poor prognosis. Challenges in HFpEF diagnosis, undifferentiated treatment of HFpEF patients despite phenotypical differences, and ignoring non-cardiac contribution to this multisystem disorder underly the unfavorable prognosis. Although exercise intolerance is the primary symptom among HFpEF patients, and current guidelines recommend exercise training, the responsible mechanisms remain unclear. Combined echocardiography and cardiopulmonary exercise testing (CPETecho) is a non-invasive method that can characterize physiological limits to exercise, including in HFpEF patients. In this study, we aim to (1) evaluate whether routine use of CPETecho can improve the accuracy of HFpEF diagnosis, (2) identify subgroups of HFpEF patients with different exercise limitations (exercise phenotypes), and (3) characterize in detail a "muscle phenotype" of HFpEF, limited mostly by peripheral muscle oxygenation instead of cardiac limits. We will recruit HFpEF patients from third-line hospitals and perform CPETecho, apply machine learning algorithms to define HFpEF phenotypes, and combine near-infrared-spectroscopy and muscle biopsies to assess peripheral oxygen extraction. Our study aims to address the clinical need for improved efficiency in HFpEF diagnosis and to identify HFpEF exercise phenotypes, contributing to the precision of HFpEF treatment.

Researcher(s)

• Promoter: Gevaert Andreas
• Co-promoter: Van De Heyning Caroline
• Fellow: De Schutter Stephanie

Research team(s)

• Cardiovascular diseases (CARDIOVASC)

Project type(s)

• Research Project

Abstract

Heart failure with preserved ejection fraction (HFpEF) is currently the most prevalent type of heart failure, with poor prognosis and few therapeutic options. Possible explanations for the poor prognosis include often late diagnosis of HFpEF when intervention is not feasible anymore, that HFpEF includes phenotypically different patients while all HFpEF patients are treated equally, and the underuse of exercise training as a part of treatment. Exercise intolerance is a universal symptom among HFpEF patients, and this can be objectively measured by peak oxygen uptake (peakVO2). Guidelines currently recommend exercise training to improve peakVO2, but the underlying pathophysiological mechanisms remain unclear. Combined echocardiography and cardiopulmonary exercise testing (CPETecho) can therefore serve as a non-invasive tool to fully characterize all the different physiologic abnormalities limiting exercise capacity. In this project, we will (1) test whether CPETecho can improve diagnosis of HFpEF, (2)prospectively identify HFpEF exercise phenotypes using comprehensive CPETecho measurements, and (3) assess the influence of exercise training on these HFpEF exercise phenotypes. To achieve this, highly detailed CPETecho analysis will be prospectively performed in HFpEF patients from 7 different referral hospitals including Antwerp University Hospital (UZA). Also, retrospectively we will analyze the OptimEx and Priority databases to determine the influence of exercise training. The outcomes of this research will contribute to the clinical need to improve efficiency in HFpEF diagnosis and thereby quality of life and will facilitate personalized treatment. The latter will result from defining HFpEF exercise phenotypes-subgroups more amenable to therapy, but also by unraveling the benefits of exercise training in these HFpEF phenotypes.

Researcher(s)

• Promoter: Gevaert Andreas
• Co-promoter: Van De Heyning Caroline
• Fellow: De Schutter Stephanie

Research team(s)

• Cardiovascular diseases (CARDIOVASC)

Project type(s)

• Research Project

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure, with limited therapeutic options and a poor prognosis. Challenges in HFpEF diagnosis, undifferentiated treatment of HFpEF patients despite phenotypical differences, and underutilization of exercise as part of therapy contribute to the unfavorable prognosis. Although exercise intolerance is a general symptom among HFpEF patients, and current guidelines recommend exercise training, the underlying pathophysiological mechanisms remain unclear. Recent research shows that combined echocardiography and cardiopulmonary exercise testing (CPETecho) is a non-invasive method that can characterize physiological limits to exercise, including in HFpEF patients. In this study, we aim to (1) evaluate whether routine use of CPETecho can improve the accuracy of HFpEF diagnosis, (2) identify subgroups of HFpEF patients with different exercise limitations (exercise phenotypes), and (3) assess the impact of exercise training on these HFpEF exercise phenotypes. We will recruit HFpEF patients from 3 third-line hospitals and perform CPETecho. We will also analyze multicentre exercise training trials to assess the influence of exercise training on HFpEF exercise phenotypes. Our study will address the clinical need for better efficiency in HFpEF diagnosis. By defining HFpEF exercise phenotypes and evaluating the benefits of exercise training, we aim to improve the precision of HFpEF treatment.

Researcher(s)

• Promoter: Gevaert Andreas
• Fellow: De Schutter Stephanie

Research team(s)

• Cardiovascular diseases (CARDIOVASC)

Project type(s)

• Research Project