Abstract
Heart failure (HF) is a complex clinical syndrome characterized by impaired exercise capacity and reduced quality of life. While musculoskeletal conditions such as degenerative lumbar spine disease (DLSD) are common in older adults, their contribution to exercise intolerance in HF patients remains under-investigated. This retrospective cohort study evaluated the relationship between DLSD and functional capacity in HF patients using cardiopulmonary exercise testing (CPET) and the six-minute walk test (6MWT). We included 286 HF patients who underwent CPET following hospitalization for acute decompensated HF. Based on imaging findings, patients were divided into DLSD (n = 143) and non-DLSD (n = 143) groups after propensity score matching for age, sex, and BMI. The DLSD group exhibited significantly poorer exercise tolerance, with lower oxygen uptake efficiency slope (OUES) (1.05 ± 0.44 vs. 1.17 ± 0.45; p = 0.017) and shorter 6MWT distances (244.9 ± 130.36 vs. 283.36 ± 132.22 m; p = 0.014). Multivariate logistic regression adjusting for age, sex, BMI, and comorbidities revealed that higher OUES and longer 6MWT distances were independently associated with reduced odds of DLSD (OUES: OR = 0.477; 95% CI: 0.259-0.879; p = 0.018; 6MWT: OR = 0.997; 95% CI: 0.995-0.999; p = 0.01). These findings suggest that DLSD may exacerbate exercise intolerance in HF and highlight the value of CPET and 6MWT in identifying high-risk subgroups. Early recognition of DLSD may facilitate tailored rehabilitation strategies to improve clinical outcomes in patients with HF.