Heart failure (HF) is a multifactorial disease for which peak oxygen uptake (VO2peak) may potentially be a prognostic marker of adverse clinical outcomes. This systematic review and meta-analysis aimed to assess published data on the prognostic impact of VO2peak in HF. A literature search of observational studies was conducted through PubMed, Scopus, Web of Science and Cochrane Library from inception until January 2025. A meta-analysis was conducted using the random-effects inverse-variance model through hazard ratios (HRs). Increased heterogeneity among studies was evaluated through meta-regressions and publication bias via Egger's test. Sixty-four studies were included in this systematic review and meta-analysis. Per 1 mL/kg/min increase in VO2peak, all-cause mortality HR: 0.86, 95% confidence interval (CI) 0.82-0.90, I2 = 85%, P < 0.01 and incident ventricular assist device, transplant and all-cause mortality (HR: 0.84, 95% CI 0.79-0.89, I2 = 33%, P < 0.01) were significantly reduced, but statistical significance of VO2peak with cardiovascular mortality was not observed (HR: 0.92, 95% CI 0.82-1.02, I2 = 0%, P = 0.12) using adjusted models. Variance among studies was detected based on age, sex, body mass index, left ventricular ejection fraction, atrial fibrillation, hypertension, chronic kidney disease, diabetes and treatment. A significant risk of publication bias was evident. VO2peak is a prognostic marker for multiple causes of mortality and hospitalization in patients with HF, which may promote further insights into patient risk stratification for adverse events and targeted management.
Prokopidis et al. (Tue,) studied this question.