Key result
HFrEF patients exhibit ~0.8 mL/kg/min lower VO2peak than HFpEF, with higher 6MWD tied to comorbidities.
Why the study?
HFrEF and HFpEF exhibit unique physiological pathways that influence exercise capacity and functional performance, but direct comparisons of these parameters between phenotypes remained to be synthesized.
Do exercise capacity and functional performance differ between HFrEF and HFpEF patients?
Meta-Analysis
Do exercise capacity and functional performance differ between HFrEF and HFpEF patients?
Effect estimate: MD -0.78 mL/kg/min (95% CI -1.45 to -0.11)
p-value: p=0.02
HFpEF patients demonstrate superior VO2peak, cardiac output, and stroke volume compared to HFrEF patients, highlighting the need for phenotype-specific rehabilitation strategies.
Supports phenotype-specific rehab strategies in HF; extends comparative evidence on exercise capacity between phenotypes.
Aims Heart failure (HF) with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) exhibit unique physiological pathways, influencing exercise capacity and functional performance. This systematic review and meta-analysis aimed to compare peak oxygen consumption (VO2peak), six-minute walk distance (6MWD), cardiac output (CO), and stroke volume (SV), between these phenotypes. Methods and results A systematic literature search of cohort studies via databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted from inception until October 2024. A meta-analysis using a random-effects model to calculate the pooled effects was employed. Forty-six studies were included. HFrEF patients demonstrated significantly greater 6MWD compared to HFpEF (k = 20; mean difference (MD): 18.09 m, 95% confidence interval (CI) 1.59–34.59, I2 = 86%, P = 0.03), though this difference became insignificant after adjusting for comorbidities. Conversely, HFpEF patients exhibited higher VO2peak (k = 20; MD: −0.78 mL/kg/min, 95% CI −1.45–−0.11, I2 = 89%, P = 0.02), CO (k = 12; MD: −1.15 L/min, 95% CI −2.11–−0.19, I2 = 97%, P = 0.02), and SV (k = 14; SMD: −1.00, 95% CI −1.60–−0.39, I2 = 95%, P < 0.01). Age was identified as a significant moderator of VO2peak. Conclusion HFpEF patients demonstrated superior VO2peak, CO, and SV compared to HFrEF patients, while the observed 6MWD advantage in HFrEF was likely influenced by comorbidities. Our findings emphasize the importance of tailoring rehabilitation strategies to HF phenotype-specific physiological profiles, particularly focusing on improving VO2peak and cardiac efficiency in HFpEF.
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Prokopidis et al. (2025) conducted a meta-analysis in Heart failure (HFrEF and HFpEF). HFrEF vs. HFpEF was evaluated on Peak oxygen consumption (VO2peak) (MD -0.78 mL/kg/min, 95% CI -1.45 to -0.11, p=0.02). HFrEF patients had lower VO2peak (MD -0.78 mL/kg/min; 95% CI -1.45 to -0.11; P=0.02) and higher 6MWD (MD 18.09 m; P=0.03) than HFpEF patients, though the 6MWD difference was tied to comorbidities.
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