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Introduction Identifying and managing heart failure with preserved ejection fraction (HFpEF) remains challenging. Despite scoring systems suggested by the European Heart Failure Association (EHFA), the majority of HFpEF patients remain unidentified and miss out on the appropriate treatment and management. Cardiopulmonary exercise testing (CPET) may help identify patients earlier and help inform treatment. This study aims to investigate the role of CPET in the identification and management of patients with HFpEF.Methods A cross-sectional study was conducted at the cardiac investigations unit, Ulster Hospital, Dundonald. It involved 13 patients with a high suspicion of HFpEF based on symptoms, Echocardiographic findings (LVSF >50%) and NT-ProBNP levels. Each patient underwent maximum exercise testing until exhaustion during which cardiac, respiratory, metabolic and musculoskeletal systems were assessed breath to breath and beat to beat.Results Thirteen (13) patients with HFpEF were included (61.7 ± 5.6 years; 84% female). Applying EHFA scoring systems, 8 (61.5%) remained unidentified. CPET results of the 8 unidentified patient‘s showed low cardio-ventilatory efficiency highly indicative of HFpEF corresponding to VO 2 peak (figure 1), VE/VCO2, O2 Pulse and OUES recorded to be 13.8 ± 9.8, 11.7 ± 4.5ml and 1805 ± 734ml/min respectively. The VO2 at anaerobic threshold was found to be 10.1 ± 4ml/kg/min with a corresponding heart rate (HR) of 113 ± 5bpm. Fatmax occurred at 32 ± 7% of VO2 peak with a corresponding HR range of 104–109bpm.Conclusions CPET proves to be a valuable tool to identify HFpEF and devise targeted cardiac rehabilitation in specific heart rate zones.Abstract 34 Figure 1Box and whisker plot representing data for VO2 peak compared to healthy age matched individuals