Faculty, Staff and Student Publications

Language

English

Publication Date

4-1-2025

Journal

CJC Open

DOI

10.1016/j.cjco.2025.01.012

PMID

40433142

PMCID

PMC12105755

PubMedCentral® Posted Date

1-20-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Understanding the impact of heart failure (HF) phenotype on peak oxygen uptake (peak ˙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 ˙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 ˙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 ˙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.

Published Open-Access

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