Feasibility of the cardiac output response to stress test in suspected heart failure patients

Sarah J Charman, Nduka C Okwose, Clare J Taylor, Kristian Bailey, Ahmet Fuat, Arsen Ristic, Jonathan Mant, Christi Deaton, Petar M Seferovic, Andrew J S Coats, F D Richard Hobbs, Guy A MacGowan, Djordje G Jakovljevic

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    BACKGROUND: Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited.

    OBJECTIVES: (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction.

    METHODS: Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases.

    RESULTS: A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients.

    CONCLUSION: The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.

    Original languageEnglish
    Pages (from-to)805-812
    Number of pages8
    JournalFamily Practice
    Issue number5
    Early online date27 Jan 2022
    Publication statusPublished - Oct 2022

    Bibliographical note

    This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
    which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.


    • cardiac output
    • feasibility
    • general practice
    • heart failure
    • primary care


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