揭示心力衰竭表型：峰值摄氧量及其决定因素的系统回顾和荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2025.01.012

Corey R. Tomczak PhD , Stephen J. Foulkes PhD , Christopher Weinkauf BSc , Devyn Walesiak BSc , Jing Wang PhD , Veronika Schmid MSc , Sarah Paterson BSc , Wesley J. Tucker PhD , Michael D. Nelson PhD , Simon Wernhart MD, PhD , Jan Vontobel MD , David Niederseer MD, PhD , Mark J. Haykowsky PhD

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Therefore, we conducted a systematic review and meta-analysis of the evidence examining differences in peak <span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span>O<sub>2</sub> (primary objective) and its determinants (secondary objectives) between patients with HF with reduced (HFrEF) or preserved ejection fraction (HFpEF).</div></div><div><h3>Methods</h3><div>Studies comparing peak <span><math><mrow><mover><mi>V</mi><mo>˙</mo></mover></mrow></math></span>O<sub>2</sub> in HFrEF vs HFpEF were found through PubMed (1967-2024), Scopus (1981-2024), and Web of Science (1985-2024). Data extraction and methodologic quality assessment were completed by 2 independent coders. 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引用次数: 0

摘要

了解心力衰竭（HF）表型对峰值摄氧量（峰值V˙O2）的影响对于推进个性化治疗策略和提高患者预后至关重要。因此，我们对具有降低（HFrEF）或保留射血分数（HFpEF）的HF患者的峰值V˙O2（主要目标）及其决定因素（次要目标）差异的证据进行了系统回顾和荟萃分析。方法通过PubMed（1967-2024）、Scopus（1981-2024）和Web of Science（1985-2024）对HFrEF和HFpEF的V˙O2峰进行比较研究。数据提取和方法学质量评估由2名独立编码器完成。采用随机效应荟萃分析得出的加权平均差（WMD）和95%置信区间（95% ci）比较HFrEF和HFpEF之间的差异。筛选3107篇文章后，25项独特的研究被纳入主要结局分析(HFrEF n = 3783；HFpEF n = 3279)。V峰值˙O2(大规模杀伤性武器:-1.6 mL / kg /分钟,95%置信区间CI: -2.3 - -0.8毫升/公斤/分钟),和峰值锻炼措施的心输出量(大规模杀伤性武器:-1.1升/分钟,95%置信区间CI: -2.1 - -0.2 L / min),中风体积(大规模杀伤性武器:-10.1毫升,95%置信区间CI: -16.6 - -3.7毫升),心率(大规模杀伤性武器:4 bpm, 95%置信区间CI: 6到2 bpm),和左心室射血分数(大规模杀伤性武器:-28.2%,95%置信区间CI: -32.6%至-23.8%)显著降低,而峰值运动arterial-venous氧气区别明显高于HFrEF相比HFpEF (2.3 mL / dL, 95%置信区间CI:1.6 - -2.9 mL / dL)。结论与HFpEF相比，我们的研究结果突出了HFrEF在氧级联中的不同生理损伤，这对这些HF亚型的管理和治疗策略具有直接意义。

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Unraveling Heart Failure Phenotypes: A Systematic Review and Meta-analysis of Peak Oxygen Uptake and Its Determinants

Background

Understanding the impact of heart failure (HF) phenotype on peak oxygen uptake (peak

\dot{V}

O₂) is essential for advancing personalized treatment strategies and enhancing patient outcomes. Therefore, we conducted a systematic review and meta-analysis of the evidence examining differences in peak

\dot{V}

O₂ (primary objective) and its determinants (secondary objectives) between patients with HF with reduced (HFrEF) or preserved ejection fraction (HFpEF).

Methods

Studies comparing peak

\dot{V}

O₂ in HFrEF vs HFpEF were found through PubMed (1967-2024), Scopus (1981-2024), and Web of Science (1985-2024). Data extraction and methodologic quality assessment were completed by 2 independent coders. Differences between HFrEF and HFpEF were compared using weighted mean difference (WMD) and 95% confidence intervals (95% CIs) derived from random effects meta-analysis.

Results

After screening 3107 articles, 25 unique studies were included in the analysis for the primary outcome (HFrEF n = 3783; HFpEF n = 3279). Peak

\dot{V}

O₂ (WMD: –1.6 mL/kg/min, 95% CI: –2.3 to –0.8 mL/kg/min), and peak exercise measures of cardiac output (WMD: –1.1 L/min, 95% CI: –2.1 to –0.2 L/min), stroke volume (WMD: –10.1 mL, 95% CI: –16.6 to –3.7 mL), heart rate (WMD: –4 bpm, 95% CI: –6 to –2 bpm), and left ventricular ejection fraction (WMD: –28.2%, 95% CI: –32.6% to –23.8%) were significantly lower while peak exercise arterial-venous oxygen difference was significantly higher in HFrEF compared with HFpEF (2.3 mL/dL, 95% CI: 1.6-2.9 mL/dL).

Conclusions

Our findings highlight distinct physiological impairments along the oxygen cascade in HFrEF compared with HFpEF, with direct implications for the management and treatment strategies of these HF subtypes.

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