Non-Invasive Cardiovascular Evaluation in Heart Failure

Non-invasive assessment of cardiac function in heart failure has evolved from basic resting echocardiography and surface electrocardiography to sophisticated dynamic evaluations integrating cardiopulmonary exercise testing, impedance cardiography, inert gas rebreathing and novel optical sensing. These methods allow quantification of central haemodynamics—such as stroke volume, cardiac output and cardiac power—together with peripheral responses including ventilatory efficiency, arteriovenous oxygen difference and microvascular perfusion. Advanced approaches now capture temporal dispersion of ventricular repolarisation and employ machine-learning algorithms to detect early decompensation and distinguish heart failure with reduced ejection fraction (HFrEF) from preserved ejection fraction (HFpEF). Recent innovations in photo-plethysmography permit reproducible measurement of lung-to-finger circulation time, offering a simple bedside marker of global cardiac index. By combining multiple modalities, clinicians can stratify risk, tailor therapy and monitor response, thus advancing personalised management and improving outcomes across diverse patient populations.

Research from Nature Portfolio

Recent studies have demonstrated that in patients at risk of heart failure with non-reduced ejection fraction, subclinical abnormalities in cardiopulmonary exercise performance correlate with patient-reported symptom burden and standard echocardiographic measures. Detailed analysis of exercise capacity markers such as maximal oxygen uptake, ventilatory efficiency and cardiac power output reveals early exercise intolerance even in asymptomatic Stage B disease, with notable sex-specific differences in correlates between men and women. In parallel, a new fingertip optical sensor for lung-to-finger circulation time has shown excellent intra-subject reproducibility across age groups and heart failure severities. This technique yields highly reliable indices of global blood flow within minutes, enhancing feasibility for repeated monitoring and offering a non-invasive surrogate for cardiac index in clinical and remote settings.

Non-Invasive Cardiovascular Evaluation in Heart Failure publication trend

The graph below shows the total number of articles in non-invasive cardiovascular evaluation in heart failure across all publications each year (not limited to Nature Index journals).

Technical terms

Cardiopulmonary exercise testing (CPET): A dynamic assessment of respiratory, cardiac and muscular responses during graded exercise, yielding measures such as peak oxygen uptake (VO₂peak) and ventilatory efficiency.

Cardiac output (CO): The volume of blood pumped by the heart per minute, calculated as stroke volume multiplied by heart rate, reflecting overall cardiac function.

Ejection fraction (EF): The percentage of left ventricular blood expelled with each contraction, used to classify HFrEF (<40 %) versus HFpEF (≥50 %).

Lung-to-finger circulation time (LFCT): The interval between cessation of breath hold and peripheral desaturation nadir, measured by optical sensors to estimate global blood flow.

Impedance cardiography (bioimpedance): A non-invasive technique measuring changes in thoracic electrical impedance to derive stroke volume, cardiac output and related haemodynamic indices.

Tpeak-Tend interval (Te): The duration between the peak and end of the T wave on an ECG, indicative of ventricular repolarisation heterogeneity and arrhythmic risk.

References

1. Cardiopulmonary exercise capacity markers and their link to symptom burden in patients at risk for heart failure with non-reduced ejection fraction. Scientific Reports (2025).
2. Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients. Biomedicines (2024).
3. Evaluation of inert gas rebreathing for determination of cardiac output: influence of age, gender and body size. Hypertension Research (2018).
4. Noninvasive Hemodynamic Monitoring in Advanced Heart Failure Patients: New Approach for Target Treatments. Biomedicines (2022).
5. Lung-to-finger circulation time can be measured stably with high reproducibility by simple breath holding method in cardiac patients. Scientific Reports (2021).