Exercise intolerance remains the hallmark of heart failure (HF), and the principles of EMD&T are critical to the contemporary management of individuals with HF and cardiomyopathy. Since Donna Mancini’s seminal work in showcasing the value of CPET in risk-stratifying patients with heart failure with reduced ejection fraction (HFrEF), CPET has emerged as one of the most important tools in determining prognosis and adjudicating advanced HF therapies in this population, including cardiac transplantation.
More recently, the value and importance of CPET in heart failure with preserved ejection fraction (HFpEF) – a heterogenous syndrome with both cardiac and extra-cardiac lesions leading to functional impairments – has been recognized. In addition, exercise training remains a critical tool in the treatment of individuals with both HFrEF and HFpEF, leading to improvements in CRMF, physical function, and quality of life.
Despite its value, HF and the collective group of individuals with cardiomyopathy constitute a markedly heterogeneous group, and understanding the safety and efficacy of exercise across individual populations (e.g., hypertrophic cardiomyopathy versus arrhythmogenic right ventricular cardiomyopathy) highlights the important need for formalized training in EMD&T. In a recent publication, Agdamag et al. outlined the prognostic role of exercise testing in heart failure.