# Targeting breathing limitations to improve functional outcomes in HFpEF

> **NIH NIH K99** · UT SOUTHWESTERN MEDICAL CENTER · 2024 · $134,044

## Abstract

PROJECT SUMMARY/ABSTRACT
Dyspnea on exertion (DOE) and exercise intolerance are hallmark symptoms of heart failure with preserved
ejection fraction (HFpEF). The mechanisms of these symptoms are unknown, and no therapeutic strategy exists
for these debilitating symptoms. As such, NHLBI working groups recommend prioritizing studies that advance
understanding of HFpEF-related (patho)physiology and the primary causes of symptoms in these patients so that
novel therapeutics can be developed. DOE and exercise intolerance are also very common symptoms of obesity.
Obesity has reached epidemic levels and affects four-in-ten American adults. The prevalence of obesity rises to
eight-in-ten adults in the HFpEF population yet, the role of obesity in provoking symptoms of DOE and exercise
intolerance in HFpEF patients has, thus far, been neglected. Human studies demonstrate that obesity affects
breathing mechanics, whereby lung volume subdivisions and maximal expiratory flow are decreased, which
increases the risk of expiratory flow limitation, dynamic hyperinflation, and an altered breathing pattern during
exercise. All these obesity-related mechanical ventilatory constraints ultimately 1) increase the oxygen (O2) cost of
breathing and 2) impose a mechanical ceiling on ventilation (V̇E) during exercise, which could provoke DOE and
reduce exercise capacity. Thus, we hypothesize that obesity is likely a significant contributor to DOE and exercise
intolerance in patients with HFpEF. To date, the O2 cost of breathing and the effect of obesity-related mechanical
ventilatory constraints on DOE and exercise intolerance remains untested in patients with HFpEF. Therefore, the
overall aim of this K99/R00 proposal is to 1) investigate the O2 cost of breathing and examine how this impacts
DOE and peak exercise capacity in patients with HFpEF, and 2) reduce obesity-related mechanical ventilatory
constraints to potentially reduce DOE and increase exercise capacity in patients with HFpEF. To accomplish these
goals, we will 1) investigate the interaction of HFpEF (underlying changes in pulmonary function) and obesity
(obesity-related changes in pulmonary function) on the O2 cost of breathing during eucapnic voluntary hyperpnea,
and its association with DOE during constant load exercise and peak exercise capacity, and 2) investigate the effects
of breathing a low density helium-oxygen gas mixture (HeO2: 21% O2 and 79% He), which reduces obesity-related
mechanical ventilatory constraints (HeO2 increases maximal expiratory flow, reduces the work of breathing,
decreases expiratory flow limitation & dynamic hyperinflation, and increases VT expansion), on DOE during
constant load exercise and peak exercise capacity. We anticipate these investigations will 1) further understanding
of the role of obesity in provoking symptoms of DOE and exercise intolerance in HFpEF patients, 2) identify new
mechanisms underlying symptoms of DOE and exercise intolerance, which could dramatically alt...

## Key facts

- **NIH application ID:** 10871825
- **Project number:** 5K99HL164957-02
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** Bryce Balmain
- **Activity code:** K99 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $134,044
- **Award type:** 5
- **Project period:** 2023-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10871825

## Citation

> US National Institutes of Health, RePORTER application 10871825, Targeting breathing limitations to improve functional outcomes in HFpEF (5K99HL164957-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10871825. Licensed CC0.

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