解析心力衰竭表型：对峰值摄氧量及其决定因素的系统评价和荟萃分析
Unraveling Heart Failure Phenotypes: A Systematic Review and Meta-analysis of Peak Oxygen Uptake and Its Determinants.
作者信息
Tomczak Corey R, Foulkes Stephen J, Weinkauf Christopher, Walesiak Devyn, Wang Jing, Schmid Veronika, Paterson Sarah, Tucker Wesley J, Nelson Michael D, Wernhart Simon, Vontobel Jan, Niederseer David, Haykowsky Mark J
机构信息
College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
iCARE Laboratory, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
出版信息
CJC Open. 2025 Jan 20;7(4):367-379. doi: 10.1016/j.cjco.2025.01.012. eCollection 2025 Apr.
BACKGROUND
Understanding the impact of heart failure (HF) phenotype on peak oxygen uptake (peak O) 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 O (primary objective) and its determinants (secondary objectives) between patients with HF with reduced (HFrEF) or preserved ejection fraction (HFpEF).
METHODS
Studies comparing peak O 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 O (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.
背景
了解心力衰竭（HF）表型对峰值摄氧量（peak O）的影响对于推进个性化治疗策略和改善患者预后至关重要。因此，我们对研究射血分数降低的心力衰竭（HFrEF）或射血分数保留的心力衰竭（HFpEF）患者之间峰值O（主要目标）及其决定因素（次要目标）差异的证据进行了系统评价和荟萃分析。
方法
通过PubMed（1967 - 2024年）、Scopus（1981 - 2024年）和Web of Science（1985 - 2024年）检索比较HFrEF与HFpEF患者峰值O的研究。数据提取和方法学质量评估由2名独立编码员完成。使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。
结果
在筛选3107篇文章后，25项独特研究被纳入主要结局分析（HFrEF，n = 3783；HFpEF，n = 3279）。与HFpEF相比，HFrEF患者的峰值O（WMD：-1.6 mL/kg/min，95%CI：-2.3至-0.8 mL/kg/min）、心输出量的峰值运动测量值（WMD：-1.1 L/min，95%CI：-2.1至-0.2 L/min）、每搏输出量（WMD：-10.1 mL，95%CI：-16.6至-3.7 mL）、心率（WMD：-4次/分钟，95%CI：-6至-2次/分钟）和左心室射血分数（WMD：-28.2%，95%CI：-32.6%至-23.8%）显著降低，而峰值运动动静脉氧分差显著升高（2.3 mL/dL，95%CI：1.6 - 2.9 mL/dL）。
结论
我们的研究结果突出了HFrEF与HFpEF在氧级联反应中不同的生理损伤，这对这些HF亚型的管理和治疗策略具有直接影响。
Zotero 插件