Key result
Heart failure with reduced ejection fraction was associated with significantly lower peak oxygen uptake compared with preserved ejection fraction (WMD -1.6 mL/kg/min; 95% CI -2.3 to -0.8).
Why the study?
Understanding the impact of heart failure phenotype on peak oxygen uptake is essential for advancing personalized treatment strategies and enhancing patient outcomes.
Does peak oxygen uptake and its determinants differ between patients with HFrEF and HFpEF?
Meta-Analysis (n=7,062)
Does peak oxygen uptake and its determinants differ between patients with HFrEF and HFpEF?
Mean Difference: -1.6 (95% CI -2.3–-0.8)
Patients with HFrEF have significantly lower peak VO2 and distinct physiological impairments along the oxygen cascade compared to those with HFpEF.
Supports phenotype-specific CPET interpretation in HF; extends comparative evidence but leaves optimal management implications open.
Background Understanding the impact of heart failure (HF) phenotype on peak oxygen uptake (peak V ˙ O 2 ) 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 ˙ O 2 (primary objective) and its determinants (secondary objectives) between patients with HF with reduced (HFrEF) or preserved ejection fraction (HFpEF). Methods Studies comparing peak V ˙ O 2 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 ˙ O 2 (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.
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Tomczak et al. (2025) conducted a meta-analysis in Heart failure (n=7,062). Heart failure with reduced ejection fraction (HFrEF) vs. Heart failure with preserved ejection fraction (HFpEF) was evaluated on Peak oxygen uptake (peak VO2) (WMD -1.6 mL/kg/min, 95% CI -2.3 to -0.8). Heart failure with reduced ejection fraction was associated with significantly lower peak oxygen uptake compared with preserved ejection fraction (WMD -1.6 mL/kg/min; 95% CI -2.3 to -0.8).
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