Background .– Heart failure (HF) with a preserved (P) left ventricular (LV) ejection fraction (EF) is common, though its diagnosis and physiopathology remain unclear. We sought to compare the myocardial characteristics at rest and during submaximal exercise in patients with HFPEF and in controls.

Methods .– Standardized submaximal exercise stress echocardiography was performed in (a) 36 patients from the KaRen HFPEF-registry, whose LV EF was ≥ 45%, and (b) 10 control patients free from manifestations of HF.

Results .– During submaximal exercise LV-systolic function measured as global 4-chamber longitudinal strain was −17.2 ± 4.7% in patients with HFPEF versus −23.7 ± 3.1% in controls ( P < 0.001), LV longitudinal diastolic function, expressed as e’ was 9.9 ± 2.8 cm/s in patients, versus 14.5 ± 3 cm/s in controls ( P < 0.001), and RV longitudinal systolic function, expressed as RVs’, was 13.3 ± 3.5 cm/s in patients versus 17.7 ± 1.5 cm/s in controls ( P < 0.05). LV afterload (arterial elastance was 2.6 ± 1 mmHg/ml in patients versus 0.8 ± 1.4 mmHg/ml in controls; P < 0.001) was significantly higher in the HFPEF than in the control group, and was correlated with a decrease in LV longitudinal strain (R = 0.63, P < 0.001) during exercise.

Conclusion .– Significant abnormalities of LV-systolic and diastolic functions were revealed by exercise stress echocardiography in patients recently admitted for heart failure and with a preserved LVEF. These observations help clarifying persisting uncertainties regarding diastolic and systolic function in HFPEF and may help in selecting therapy for such patients.