The Index of Exercise Tolerance in Heart Failure with Preserved Ejection Fraction is Gait Speed
-
Masaki Takeyoshi
,
Wakana Togami
,
Kei Hiyama
,
Seiji Takashio
,
Yuichiro Arima
,
Kenichi Tsujita
,
Takeshi Miyamoto
Abstract
Introduction: Exercise tolerance, an important factor affecting life prognosis and rehospitalization in patients with chronic heart failure, is a major outcome of cardiac rehabilitation. Heart failure with preserved ejection fraction (HFpEF) from reduced diastolic capacity has recently increased among patients with chronic heart failure. This study evaluated and clarified the factors indicating exercise tolerance in patients with HFpEF from various perspectives, including cardiac and skeletal muscle functions.
Material and Methods: The subjects were 31 patients with HFpEF who underwent cardiac rehabilitation. Exercise tolerance was assessed using a 6-minute walking test. Physical function, physical activity, body composition test, baseline characteristics, blood data, and echocardiography results were extracted from medical records to identify the indicators of exercise tolerance.
Results: Gait speed was significantly different in exercise tolerance for HFpEF patients (β=0.75, p<0.01). Unlike HFrEF, HFpEF were no significant differences in brain natriuretic peptide (BNP) levels and cardiac function.
Conclusion: Gait speed is an indicator of exercise tolerance in HFpEF patients. However, its pathological course differs from HFrEF, indicating that it is poorly related to BNP, a biomarker for heart failure and cardiac function.
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6. Higginbotham MB, Morris KG, Conn EH, Coleman RE, Cobb FR. Determinants of variable exercise performance among patients with severe left ventricular dysfunction. Am J Cardiol. 1983; 51(1):52-60.
7. Wilson JR, Martin JL, Ferraro N. Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol. 1984; 53(9):1308-1315.
8. Jondeau G, Katz SD, Zohman L, Goldberger M, McCarthy M, Bourdarias JP, LeJemtel TH. Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure. Circulation. 1992; 86(5)1351-1356.
9. Izawa KP, Watanabe S, Yokoyama H, Hiraki K, Morio Y, Oka K, Osada N, Omiya K. Muscle strength in relation to disease severity in patients with congestive heart failure. Am J Phys Med Rehabil. 2007; 86(11):893-900.
10. Clark A, Rafferty D, Arbuthnott K. Relationship between isokinetic muscle strength and exercise capacity in chronic heart failure. Int J Cardiol. 1997; 59(2):145-148.
11. Harrington D, Anker SD, Chua TP, Peploe KMW, Ponikowski PP, Wilson PAP, Coats AJ. Skeletal muscle function and its relation to exercise tolerance in chronic heart failure. J Am Coll Cardiol. 1997; 30(7):1758-1764.
12. Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Takeichi N, Tsukamoto T, Osada N, Omiya K. Relation between physical activity and exercise capacity of ≥5 metabolic equivalents in middle- and older-aged patients with chronic heart failure. Disabil Rehabil. 2012; 34(23):2018-2024.
13. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006; 355(3):251-259.
14. Pandey A, Parashar A, Kumbhani D. Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail. 2015; 8(1):33-40.
15. Kamiya K, Sato Y, Takahashi T, Makaya MT, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Goto Y, Makita S, Isobe M. Multidisciplinary cardiac rehabilitation and long-term prognosis in patients with heart failure. Circ Heart Fail. 2020; 13(10):e006798.
16. Dhakal BP, Malhotra R, Murphy RM, Pappagianopoulos PP, Baggish AL, Weiner RB, Houstis NE, Eisman AS, Hough SS, Lewis GD. Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction. Circ Heart Fail. 2015; 8(2):286-294.
17. Kitzman DW, Nicklas B, Kraus WE, Lyles MF, Eggebeen J, Morgan TM, Haykowsky M. Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ. Physiol. 2014; 306(9):1364-1370.
18. Nagueh SF, Smiseth OA, Appleton CP, Byrd 3rd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016;17:1321-1360.
19. Andersen OS, Smiseth OA, Dokainish H, Abudiab MM, Schutt RC, Kumar A, Sato K, Harb S, Gude E, Remme EW, Andreassen AK, Ha JW, Xu J, Klein AL, Nagueh SH. Estimating left ventricular filling pressure by echocardiography. J Am Coll Cardiol. 2017; 69:1937-1948.
20. Giangregorio ML, Webber CE. Effects of metal implants on whole-body dual-energy x-ray absorptiometry measurements of bone mineral content and body composition. Can Assoc Radiol J. 2003; 54(5):305-309.
21. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-117.
22. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020; 21(3):300-307.
23. Cohen JB, Schrauben SJ, Zhao L, Basso MD, Cvijic ME, Li Z, Yarde M, Wang Z, Bhattacharya PT, Chirinos DA, Prenner S, Zamani P, Seiffert DA, Car BS, Gordon DA, Margulies K, Cappola T, Chirinos JA. Clinical phenogroups in heart failure with preserved ejection fraction: detailed phenotypes, prognosis, and response to spironolactone. JACC Heart Fail. 2020; 8(3):172-184.
24. Campbell RT, Jhund PS, Castagno D, Hawkins NM, Petrie MC, McMurray JJV. What have we learned about patients with heart failure and preserved ejection fraction from DIG‐PEF, CHARM‐preserved, and I‐PRESERVE? J Am Coll Cardiol. 2012; 60(23):2349-2356.
25. Nagai T, Yoshikawa T, Saito Y. Takeishi Y, Yamamoto K, Ogawa H, Anzai T, JASPER Investigators. Clinical characteristics, management, and outcomes of Japanese patients hospitalized for heart failure with preserved ejection fraction- a report from the Japanese heart failure syndrome with preserved ejection fraction (JASPER) Registry. Circ J. 2018; 82(6):1534-1545.
26. Teramoto K, Teng THK, Chandramouli C, Tromp J, Sakata Y, Lam CS. Epidemiology and Clinical Features of Heart Failure with Preserved Ejection Fraction. Cardiac Failure Review.2022;8:e27.
27. Pettinger M, Rossouw J, Martin LW, Foraker R, Quddus A, Liu S, Wampler NS, Wu WCH, Manson JE, Margolis K, Johnson KC, Allison M, Smith GC, Rosamond W, Breathett K, Klein L. Risk factors for incident hospitalized heart failure with preserved versus reduced ejection fraction in a multiracial cohort of postmenopausal women. Circ Heart Fail. 2016; 9(10):e002883.
28. Redfield MM, Anstrom KJ, Levine JA, Koepp GA, Borlaug BA, Chen HH, LeWinter MM, Joseph SM, Shah SJ, Semigran MJ, Felker GM, Cole RT, Reeves GR, Tedford RJ, Tang WHW, McNulty SE, Velazquez EJ, Shah MR, Braunwald E. Isosorbide mononitrate in heart failure with preserved ejection fraction. N Engl J Med. 2015; 373(24):2314-2324.
29. Udelson JE, Lewis GD, Shah SJ, Zile MR, Redfield MM, Burnett Jr J, Parker J, Seferovic JP, Wilson P, Mittleman RS, Profy AT, Konstam MA. Effect of praliciguat on peak rate of oxygen consumption in patients with heart failure with preserved ejection fraction: the CAPACITY HFpEF randomized clinical trial. JAMA. 2020; 324(15):1522-1531.
30. Kanagala P, Arnold JR, Singh A, Chan DCS, Cheng ASH, Khan JN, Gulsin GS, Yang J, Zhao L, Gupta P, Squire IB, Ng LL, McCann GP. Characterizing heart failure with preserved and reduced ejection fraction: an imaging and plasma biomarker approach. PLoS One. 2020; 15(4):e0232280.
31. Kamiya K, Hamazaki N, Matsue Y, Mezzani A, Corrà U, Matsuzawa R, Nozaki K, Tanaka S, Maekawa E, Noda C, Tojo MY, Matsunaga A, Masuda T, Ako J. Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease. Eur J Prev Cardiol. 2018; 25(2):212-219.
32. Haykowsky MJ, Brubaker PH, John JM, Stewart KP, Morgan TM, Kitzman DW. Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. J Am Coll Cardiol. 2011; 58(3):265-274.
33. Yamada M, Kimura Y, Ishiyama D, Nishio N, Abe Y, Kakehi T, Fujimoto J, Tanaka T, Ohji S, Otobe Y, Koyama S, Okajima Y, Arai H. Differential characteristics of skeletal muscle in community-dwelling older adults. J Am Med Dir Assoc. 2017; 18(9):807.e9-807.e16.
34. Kitzman DW, Shah SJ. The HFpEF obesity phenotype: the elephant in the room. J Am Coll Cardiol. 2016; 68 (2): 200-203.
35. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci. 2012; 67(1): 28-40.
36. Konishi M, Kagiyama N, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, Misumi T, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Makino A, Oka K, Momomura S, Matsue Y. Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction. Eur J Prev Cardiol. 2020; zwaa.117.
37. Pandey A, Patel KV, Vaduganathan M, Sarma S, Haykowsky MJ, Berry JD, Lavie CJ. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail. 2018; 6(12):975-982.
38. Liu M, Fang F, Yu C. Noncardiac comorbidities in heart failure with preserved ejection fraction - commonly ignored fact. Circ J. 2015; 79(5):954-959.
39. Santos M, Opotowsky AR, Shah AM, Tracy J, Waxman AB, Systrom DM. Central cardiac limit to aerobic capacity in patients with exertional pulmonary venous hypertension: implications for heart failure with preserved ejection fraction. Circ Heart Fail. 2015; 8(2):278-285.
2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Juanatey JRG, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, Meer PVD. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology. Eur Heart J. 2016; 37:2129-2200.
3. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002; 346(11):793-801.
4. Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA. Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J. 2004; 147(2):354-360.
5. Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI, Kronenberg MW, Kostis JB, Kohn RM, Guillotte M. Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. JAMA. 1993; 270(14):1702-1707.
6. Higginbotham MB, Morris KG, Conn EH, Coleman RE, Cobb FR. Determinants of variable exercise performance among patients with severe left ventricular dysfunction. Am J Cardiol. 1983; 51(1):52-60.
7. Wilson JR, Martin JL, Ferraro N. Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol. 1984; 53(9):1308-1315.
8. Jondeau G, Katz SD, Zohman L, Goldberger M, McCarthy M, Bourdarias JP, LeJemtel TH. Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure. Circulation. 1992; 86(5)1351-1356.
9. Izawa KP, Watanabe S, Yokoyama H, Hiraki K, Morio Y, Oka K, Osada N, Omiya K. Muscle strength in relation to disease severity in patients with congestive heart failure. Am J Phys Med Rehabil. 2007; 86(11):893-900.
10. Clark A, Rafferty D, Arbuthnott K. Relationship between isokinetic muscle strength and exercise capacity in chronic heart failure. Int J Cardiol. 1997; 59(2):145-148.
11. Harrington D, Anker SD, Chua TP, Peploe KMW, Ponikowski PP, Wilson PAP, Coats AJ. Skeletal muscle function and its relation to exercise tolerance in chronic heart failure. J Am Coll Cardiol. 1997; 30(7):1758-1764.
12. Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Takeichi N, Tsukamoto T, Osada N, Omiya K. Relation between physical activity and exercise capacity of ≥5 metabolic equivalents in middle- and older-aged patients with chronic heart failure. Disabil Rehabil. 2012; 34(23):2018-2024.
13. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006; 355(3):251-259.
14. Pandey A, Parashar A, Kumbhani D. Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail. 2015; 8(1):33-40.
15. Kamiya K, Sato Y, Takahashi T, Makaya MT, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Goto Y, Makita S, Isobe M. Multidisciplinary cardiac rehabilitation and long-term prognosis in patients with heart failure. Circ Heart Fail. 2020; 13(10):e006798.
16. Dhakal BP, Malhotra R, Murphy RM, Pappagianopoulos PP, Baggish AL, Weiner RB, Houstis NE, Eisman AS, Hough SS, Lewis GD. Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction. Circ Heart Fail. 2015; 8(2):286-294.
17. Kitzman DW, Nicklas B, Kraus WE, Lyles MF, Eggebeen J, Morgan TM, Haykowsky M. Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ. Physiol. 2014; 306(9):1364-1370.
18. Nagueh SF, Smiseth OA, Appleton CP, Byrd 3rd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016;17:1321-1360.
19. Andersen OS, Smiseth OA, Dokainish H, Abudiab MM, Schutt RC, Kumar A, Sato K, Harb S, Gude E, Remme EW, Andreassen AK, Ha JW, Xu J, Klein AL, Nagueh SH. Estimating left ventricular filling pressure by echocardiography. J Am Coll Cardiol. 2017; 69:1937-1948.
20. Giangregorio ML, Webber CE. Effects of metal implants on whole-body dual-energy x-ray absorptiometry measurements of bone mineral content and body composition. Can Assoc Radiol J. 2003; 54(5):305-309.
21. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-117.
22. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020; 21(3):300-307.
23. Cohen JB, Schrauben SJ, Zhao L, Basso MD, Cvijic ME, Li Z, Yarde M, Wang Z, Bhattacharya PT, Chirinos DA, Prenner S, Zamani P, Seiffert DA, Car BS, Gordon DA, Margulies K, Cappola T, Chirinos JA. Clinical phenogroups in heart failure with preserved ejection fraction: detailed phenotypes, prognosis, and response to spironolactone. JACC Heart Fail. 2020; 8(3):172-184.
24. Campbell RT, Jhund PS, Castagno D, Hawkins NM, Petrie MC, McMurray JJV. What have we learned about patients with heart failure and preserved ejection fraction from DIG‐PEF, CHARM‐preserved, and I‐PRESERVE? J Am Coll Cardiol. 2012; 60(23):2349-2356.
25. Nagai T, Yoshikawa T, Saito Y. Takeishi Y, Yamamoto K, Ogawa H, Anzai T, JASPER Investigators. Clinical characteristics, management, and outcomes of Japanese patients hospitalized for heart failure with preserved ejection fraction- a report from the Japanese heart failure syndrome with preserved ejection fraction (JASPER) Registry. Circ J. 2018; 82(6):1534-1545.
26. Teramoto K, Teng THK, Chandramouli C, Tromp J, Sakata Y, Lam CS. Epidemiology and Clinical Features of Heart Failure with Preserved Ejection Fraction. Cardiac Failure Review.2022;8:e27.
27. Pettinger M, Rossouw J, Martin LW, Foraker R, Quddus A, Liu S, Wampler NS, Wu WCH, Manson JE, Margolis K, Johnson KC, Allison M, Smith GC, Rosamond W, Breathett K, Klein L. Risk factors for incident hospitalized heart failure with preserved versus reduced ejection fraction in a multiracial cohort of postmenopausal women. Circ Heart Fail. 2016; 9(10):e002883.
28. Redfield MM, Anstrom KJ, Levine JA, Koepp GA, Borlaug BA, Chen HH, LeWinter MM, Joseph SM, Shah SJ, Semigran MJ, Felker GM, Cole RT, Reeves GR, Tedford RJ, Tang WHW, McNulty SE, Velazquez EJ, Shah MR, Braunwald E. Isosorbide mononitrate in heart failure with preserved ejection fraction. N Engl J Med. 2015; 373(24):2314-2324.
29. Udelson JE, Lewis GD, Shah SJ, Zile MR, Redfield MM, Burnett Jr J, Parker J, Seferovic JP, Wilson P, Mittleman RS, Profy AT, Konstam MA. Effect of praliciguat on peak rate of oxygen consumption in patients with heart failure with preserved ejection fraction: the CAPACITY HFpEF randomized clinical trial. JAMA. 2020; 324(15):1522-1531.
30. Kanagala P, Arnold JR, Singh A, Chan DCS, Cheng ASH, Khan JN, Gulsin GS, Yang J, Zhao L, Gupta P, Squire IB, Ng LL, McCann GP. Characterizing heart failure with preserved and reduced ejection fraction: an imaging and plasma biomarker approach. PLoS One. 2020; 15(4):e0232280.
31. Kamiya K, Hamazaki N, Matsue Y, Mezzani A, Corrà U, Matsuzawa R, Nozaki K, Tanaka S, Maekawa E, Noda C, Tojo MY, Matsunaga A, Masuda T, Ako J. Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease. Eur J Prev Cardiol. 2018; 25(2):212-219.
32. Haykowsky MJ, Brubaker PH, John JM, Stewart KP, Morgan TM, Kitzman DW. Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. J Am Coll Cardiol. 2011; 58(3):265-274.
33. Yamada M, Kimura Y, Ishiyama D, Nishio N, Abe Y, Kakehi T, Fujimoto J, Tanaka T, Ohji S, Otobe Y, Koyama S, Okajima Y, Arai H. Differential characteristics of skeletal muscle in community-dwelling older adults. J Am Med Dir Assoc. 2017; 18(9):807.e9-807.e16.
34. Kitzman DW, Shah SJ. The HFpEF obesity phenotype: the elephant in the room. J Am Coll Cardiol. 2016; 68 (2): 200-203.
35. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci. 2012; 67(1): 28-40.
36. Konishi M, Kagiyama N, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, Misumi T, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Makino A, Oka K, Momomura S, Matsue Y. Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction. Eur J Prev Cardiol. 2020; zwaa.117.
37. Pandey A, Patel KV, Vaduganathan M, Sarma S, Haykowsky MJ, Berry JD, Lavie CJ. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail. 2018; 6(12):975-982.
38. Liu M, Fang F, Yu C. Noncardiac comorbidities in heart failure with preserved ejection fraction - commonly ignored fact. Circ J. 2015; 79(5):954-959.
39. Santos M, Opotowsky AR, Shah AM, Tracy J, Waxman AB, Systrom DM. Central cardiac limit to aerobic capacity in patients with exertional pulmonary venous hypertension: implications for heart failure with preserved ejection fraction. Circ Heart Fail. 2015; 8(2):278-285.
| Files | ||
| Issue | Vol 18 No 1 (2024) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v18i1.14734 | |
| Keywords | ||
| Exercise Tolerance, Gait Speed, Heart Failure | ||
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How to Cite
1.
Takeyoshi M, Togami W, Hiyama K, Takashio S, Arima Y, Tsujita K, Miyamoto T. The Index of Exercise Tolerance in Heart Failure with Preserved Ejection Fraction is Gait Speed. jmr. 2024;18(1):93-105.
