Hashiba M; University of Copenhagen, Copenhagen,Denmark.
Hansen MT; Helge JW; Nielsen SK; Gustavsen PH; Mohamed AA; Holt
A; Elmegaard M; Petersen CS; Schou M; Lamberts MK; Wolsk E

International Journal of Cardiology. 451:134252, 2026 May 15.

BACKGROUND: Peak oxygen consumption (pVO2) is a key predictor of mortality
and morbidity in patients with heart failure with reduced ejection
fraction (HFrEF).

METHODS: From December 2022 to September 2023, patients with new-onset
HFrEF were prospectively enrolled from a heart failure outpatient clinic.
All patients underwent at least 12 weeks of guideline-directed medical
therapy (GDMT) initiation and management, including physical training and
education. Cardiopulmonary exercise testing (CPET), medication,
echocardiography, and clinical data were collected at baseline and after
12 weeks. Associations with pVO2 changes were examined using univariable
and multivariable regression analyses.

RESULTS: We included 48 patients (median age 73 years, 20.8% women) with
baseline left ventricular ejection fraction (LVEF) of 30% +/- 7 and pVO2
of 18.1 +/- 5.6 mL/min/kg. After 12 weeks, pVO2 increased by 2.2 mL/min/kg
(95% CI: 1.3-3.1, p < 0.001) and LVEF improved to 44% (+14% [95% CI:
12-17, p < 0.001]). In the multivariable model, reductions in N-terminal
pro-B-type natriuretic peptide (NT-proBNP) and body mass index (BMI) were
associated with higher pVO2 (beta = -1.11 [95% CI: -2.15 to -0.06, p =
0.039]; beta = -1.62 [95% CI: -2.99 to -0.25, p = 0.023]). Higher left
atrial end-systolic volume index (LAESVi) was also associated with
increased pVO2 (beta = 0.23 [95% CI: 0.10-0.35, p = 0.001]).

CONCLUSION: GDMT was associated with improvements in cardiorespiratory
fitness and LVEF in patients with new-onset HFrEF. Reductions in
NT-proBNP, decreases in BMI, and increases in LAESVi were independently
associated with pVO2 improvements after 12 weeks.