Konstantinos Prokopidis, Krzysztof Irlik, Julia Piaśnik, Zuzanna Michalska, Mirela Hendel, Katarzyna Nabrdalik, Gregory Y.H. Lip
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Increased heterogeneity among studies was evaluated through meta-regressions and publication bias via Egger's test.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Sixty-four studies were included in this systematic review and meta-analysis. Per 1 mL/kg/min increase in VO<sub>2</sub>peak, all-cause mortality [HR: 0.86, 95% confidence interval (CI) 0.82–0.90, <i>I</i><sup>2</sup> = 85%, <i>P</i> < 0.01] and incident ventricular assist device, transplant and all-cause mortality (HR: 0.84, 95% CI 0.79–0.89, <i>I</i><sup>2</sup> = 33%, <i>P</i> < 0.01) were significantly reduced, but statistical significance of VO<sub>2</sub>peak with cardiovascular mortality was not observed (HR: 0.92, 95% CI 0.82–1.02, <i>I</i><sup>2</sup> = 0%, <i>P</i> = 0.12) using adjusted models. Variance among studies was detected based on age, sex, body mass index, left ventricular ejection fraction, atrial fibrillation, hypertension, chronic kidney disease, diabetes and treatment. 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引用次数: 0
摘要
背景和目的：心力衰竭（HF）是一种多因素疾病，其峰值摄氧量（vo2峰值）可能是不良临床结果的预后标志。本系统综述和荟萃分析旨在评估已发表的关于心力衰竭患者vo2峰值对预后影响的数据。方法：通过PubMed、Scopus、Web of Science和Cochrane Library从成立到2025年1月对观察性研究进行文献检索。采用随机效应反方差模型通过风险比（hr）进行meta分析。通过meta回归和Egger检验的发表偏倚来评估研究之间增加的异质性。结果：64项研究被纳入本系统综述和荟萃分析。使用校正模型，每增加1 mL/kg/min，全因死亡率[HR: 0.86, 95%可信区间（CI） 0.82-0.90, I2 = 85%, P 2 = 33%]未观察到p2峰值与心血管死亡率（HR: 0.92, 95% CI 0.82-1.02, I2 = 0%, P = 0.12）。根据年龄、性别、体重指数、左心室射血分数、心房颤动、高血压、慢性肾脏疾病、糖尿病和治疗来检测研究之间的差异。明显存在显著的发表偏倚风险。结论：vo2峰值是心衰患者多原因死亡和住院的预后指标，可能有助于进一步了解患者不良事件的风险分层和针对性管理。
Prognostic impact of peak oxygen consumption in heart failure: A systematic review and meta-analysis
Background and Aims
Heart failure (HF) is a multifactorial disease for which peak oxygen uptake (VO2peak) may potentially be a prognostic marker of adverse clinical outcomes. This systematic review and meta-analysis aimed to assess published data on the prognostic impact of VO2peak in HF.
Methods
A literature search of observational studies was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until January 2025. A meta-analysis was conducted using the random-effects inverse-variance model through hazard ratios (HRs). Increased heterogeneity among studies was evaluated through meta-regressions and publication bias via Egger's test.
Results
Sixty-four studies were included in this systematic review and meta-analysis. Per 1 mL/kg/min increase in VO2peak, all-cause mortality [HR: 0.86, 95% confidence interval (CI) 0.82–0.90, I2 = 85%, P < 0.01] and incident ventricular assist device, transplant and all-cause mortality (HR: 0.84, 95% CI 0.79–0.89, I2 = 33%, P < 0.01) were significantly reduced, but statistical significance of VO2peak with cardiovascular mortality was not observed (HR: 0.92, 95% CI 0.82–1.02, I2 = 0%, P = 0.12) using adjusted models. Variance among studies was detected based on age, sex, body mass index, left ventricular ejection fraction, atrial fibrillation, hypertension, chronic kidney disease, diabetes and treatment. A significant risk of publication bias was evident.
Conclusions
VO2peak is a prognostic marker for multiple causes of mortality and hospitalization in patients with HF, which may promote further insights into patient risk stratification for adverse events and targeted management.
期刊介绍：
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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