An Abbreviated Exercise Right-Heart Catheterization Protocol for the Diagnosis of Heart Failure With Preserved Ejection Fraction.

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) can only be confirmed invasively by using exercise right-heart catheterization (eRHC). Many centers do not perform eRHC, because the current, well-established, eRHC protocol can be time consuming and costly. We sought to determine whether an abbreviated 3-minute exercise protocol could accurately diagnose HFpEF.

METHODS

We performed a retrospective analysis of all patients who underwent eRHC at the Alfred Hospital in Melbourne, Australia, between September 2008 and August 2025, which comprised a derivation cohort (n = 518) and an independent internal-validation cohort (n = 255). We used receiver operating characteristic analysis to assess the diagnostic value of the 3-minute eRHC protocol as compared to the standard protocol of using peak exercise. Correlations between hemodynamic measurements at 3 minutes and peak exercise were assessed.

RESULTS

Pulmonary capillary wedge pressure ≥21 mmHg at 3 minutes had good sensitivity (85%) and specificity (85%) for diagnosis of HFpEF, with a robust c-statistic of 0.93 ± 0.01. There were strong positive correlations for the variables PCWP (R2 = 0.6946), cardiac output (R2 = 0.5392), and pulmonary vascular resistance (R2 = 0.6348), between 3 minutes and peak exercise. The diagnostic capabilities of the abbreviated protocol were confirmed in the validation cohort, maintaining high sensitivity (86%) and specificity (79%).

CONCLUSIONS

An abbreviated 3-minute eRHC protocol has good diagnostic potential in HFpEF, with strong correlations in hemodynamics, when compared to peak exercise. Simplification of the current protocol to 3 minutes of exercise only could be a valid strategy to enable improved uptake, maximize resource use, and reduce patient risk, while maintaining diagnostic accuracy.