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Importance: Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects., Objective: To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF., Design, Setting, and Participants: Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded., Interventions: Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise)., Main Outcomes and Measures: Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months., Results: Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs -0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs -0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, -0.4 [95% CI, -1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%)., Conclusions and Relevance: Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF., Trial Registration: ClinicalTrials.gov Identifier: NCT02078947.

Objective: Exercise systolic pulmonary arterial pressure (SPAP) predicts the occurrence of symptoms in patients with degenerative mitral regurgitation (MR). However, this measurement is not always available. The purpose of this study was to identify resting echocardiographic predictors of exercise SPAP and whether predicted exercise SPAP may predict symptom-free survival., Methods: We prospectively enrolled 89 consecutive asymptomatic patients with moderate or greater degenerative MR in whom exercise SPAP was measurable. Left ventricular (LV) systolic and diastolic function were assessed by comprehensive transthoracic echocardiography. Tissue Doppler imaging was used to measure Ea- (early diastolic) and Sa- (systolic) wave velocities and time-to-peak (TP) Sa velocity. Multiple linear regression was built to identify resting predictors of exercise SPAP., Results: Patients with exercise pulmonary hypertension (PHT) (n = 45, 51%) were significantly older and more frequently male, and had shorter TP-Sa velocity and higher E/Ea ratio and LV end-diastolic volume than those without exercise PHT. Exercise SPAP was best correlated with resting LV end-diastolic volume (r = 0.55), TP-Sa (r = 0.72), and E/Ea ratio (r = 0.52). Multiple linear regression analysis allowed us to build the following predictive equation with good precision (r(2) = 0.80): By using this formula, predicted exercise SPAP was well correlated with observed exercise SPAP (r = 0.89). Predicted exercise PHT was associated with significant reduced symptom-free survival in both univariate (P = .04) and multivariate (P = .045) analyses., Conclusion: In asymptomatic patients with degenerative MR, exercise PHT can be accurately predicted using resting comprehensive echocardiography., (Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)