Bingel Anne, Messroghli Daniel, Weimar Andreas, Runte Kilian, Salcher-Konrad Maximilian, Kelle Sebastian, Pieske Burkert, Berger Felix, Kuehne Titus, Goubergrits Leonid, Fuerstenau Daniel, Kelm Marcus
Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany.
Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Front Cardiovasc Med. 2022 Apr 19;9:718114. doi: 10.3389/fcvm.2022.718114. eCollection 2022.
Although disease etiologies differ, heart failure patients with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) both present with clinical symptoms when under stress and impaired exercise capacity. The extent to which the adaptation of heart rate (HR), stroke volume (SV), and cardiac output (CO) under stress conditions is altered can be quantified by stress testing in conjunction with imaging methods and may help to detect the diminishment in a patient's condition early. The aim of this meta-analysis was to quantify hemodynamic changes during physiological and pharmacological stress testing in patients with HF. A systematic literature search (PROSPERO 2020:CRD42020161212) in MEDLINE was conducted to assess hemodynamic changes under dynamic and pharmacological stress testing at different stress intensities in HFpEF and HFrEF patients. Pooled mean changes were estimated using a random effects model. Altogether, 140 study arms with 7,248 exercise tests were analyzed. High-intensity dynamic stress testing represented 73% of these data (70 study arms with 5,318 exercise tests), where: HR increased by 45.69 bpm (95% CI 44.51-46.88; = 98.4%), SV by 13.49 ml (95% CI 6.87-20.10; = 68.5%), and CO by 3.41 L/min (95% CI 2.86-3.95; = 86.3%). No significant differences between HFrEF and HFpEF groups were found. Despite the limited availability of comparative studies, these reference values can help to estimate the expected hemodynamic responses in patients with HF. No differences in chronotropic reactions, changes in SV, or CO were found between HFrEF and HFpEF. When compared to healthy individuals, exercise tolerance, as well as associated HR and CO changes under moderate-high dynamic stress, was substantially impaired in both HF groups. This may contribute to a better disease understanding, future study planning, and patient-specific predictive models.
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020161212].
尽管疾病病因不同，但射血分数保留和降低的心力衰竭患者（分别为HFpEF和HFrEF）在应激状态下均会出现临床症状且运动能力受损。应激条件下心率（HR）、每搏输出量（SV）和心输出量（CO）的适应变化程度可通过结合成像方法的应激测试进行量化，这可能有助于早期检测患者病情的恶化。本荟萃分析的目的是量化心力衰竭患者在生理和药理应激测试期间的血流动力学变化。在MEDLINE中进行了系统的文献检索（PROSPERO 2020：CRD42020161212），以评估HFpEF和HFrEF患者在不同应激强度下动态和药理应激测试中的血流动力学变化。使用随机效应模型估计合并平均变化。总共分析了140个研究组的7248次运动测试。高强度动态应激测试占这些数据的73%（70个研究组的5318次运动测试），其中：HR增加45.69次/分钟（95%CI 44.51 - 46.88； = 98.4%），SV增加13.49毫升（95%CI 6.87 - 20.10； = 68.5%），CO增加3.41升/分钟（95%CI 2.86 - 3.95； = 86.3%）。未发现HFrEF组和HFpEF组之间存在显著差异。尽管比较研究的可用性有限，但这些参考值有助于估计心力衰竭患者预期的血流动力学反应。在变时反应、SV变化或CO方面，未发现HFrEF和HFpEF之间存在差异。与健康个体相比，两个心力衰竭组在中 - 高动态应激下的运动耐量以及相关的HR和CO变化均显著受损。这可能有助于更好地理解疾病、规划未来研究以及建立针对患者的预测模型。
