Relationship of Arterial Tonometry and Exercise in Patients With Chronic Heart Failure: a Systematic Review With Meta-analysis and Trial Sequential Analysis

Background Arterial stiffness is a common characteristic in patients with chronic heart failure (CHF), and arterial tonometric technologies related to arterial stiffness are novel and effective methods and have an important value in the diagnosis and prognosis of CHF. In terms of ameliorating arterial stiffness in patients with CHF, exercise training is considered an adjuvant treatment and also an effective means in the diagnosis and judgment of prognosis. However, there are huge controversies and inconsistencies in these aspects. The objective of this meta-analysis was to systematically test the connection of arterial tonometry and exercise in patients with CHF. Methods and results MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library were searched from inception to 2 June 2021. Eighteen articles were included, with a total of 876 participants satisfied the inclusion criteria. The pooling revealed that flow-mediated dilation (FMD) was lower in basal condition [standardized mean difference (SMD): -2.28%, 95% confidence interval (CI): -3.47 to -1.08, P<0.001] and improved significantly after exercise (SMD: 5.96%, 95%CI: 2.81 to 9.05, P<0.001) in patients with heart failure with reduced ejection fraction (HFrEF) compared with normal participants. High-intensity training exercise was more beneficial (SMD: 2.88%, 95% CI: 1.78 to 3.97, P<0.001) than moderate-intensity training exercise to improve FMD in patients with CHF. For augmentation index (AIx), our study indicated no significant differences (SMD: 0.50%, 95% CI: -0.05 to 1.05, p = 0.074) in patients with heart failure with preserved ejection fraction (HFpEF) compared with normal participants. However, other outcomes of our study were not identified after further verification using TSA, and more high-quality studies are needed to reach definitive conclusions in the future. Conclusions This review shows that FMD is lower in basal condition and improves significantly after exercise in patients with HFrEF compared with normal participants; high-intensity training exercise is more beneficial than moderate-intensity training exercise to improve FMD in patients with CHF; besides, there are no significant differences in AIx in patients with HFpEF compared with normal participants. More high-quality studies on this topic are warranted.