Cargando…

Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis

BACKGROUND: While exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters. METHODS: A comprehensive systematic s...

Descripción completa

Detalles Bibliográficos
Autores principales: Edwards, Jamie J., O’Driscoll, Jamie M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177931/
https://www.ncbi.nlm.nih.gov/pubmed/35674912
http://dx.doi.org/10.1186/s40798-022-00464-5
_version_ 1784722946640576512
author Edwards, Jamie J.
O’Driscoll, Jamie M.
author_facet Edwards, Jamie J.
O’Driscoll, Jamie M.
author_sort Edwards, Jamie J.
collection PubMed
description BACKGROUND: While exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters. METHODS: A comprehensive systematic search was performed to identify trials published between 1990 and May 2021. Controlled trials of adults reporting pre- and post-ET peak VO2, 6-min walk distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) and left ventricular ejection fraction (LVEF) were considered. Parameters of cardiac diastolic function, brain natriuretic peptides (BNP)/N-terminal prohormone of BNP (NTproBNP) and follow-up hospitalisation and mortality data were also analysed. RESULTS: Ninety-three studies (11 HFpEF and 82 HFrEF) were included in the final analysis, with a pooled sample size of 11,081 participants. HFpEF analysis demonstrated significant improvements in peak VO2 (weighted mean difference: 2.333 ml·min(-1)·kg(-1), P(fixed) < 0.001), 6MWD (WMD: 35.396 m, P(fixed) < 0.001), MLHFQ (WMD: − 10.932, P(random) < 0.001), KCCQ (WMD: 3.709, P(fixed) = 0.037) and E/e′ (WMD: − 1.709, [95% CI] = − 2.91–0.51, P(random) = 0.005). HFrEF analysis demonstrated significant improvements in peak VO2 (WMD: 3.050 ml·min(-1)·kg(-1), P(random) < 0.001), 6MWD (WMD: 37.299 m, P(random) < 0.001), MLHFQ (WMD: − 10.932, P(random) < 0.001), LVEF (WMD: 2.677%, P(random) = 0.002) and BNP/NTproBNP (SMD: − 1.349, P(random) < 0.001). Outcome analysis was only performed in HFrEF, which found no significant changes in hospitalisation, all-cause mortality or composite end-points. CONCLUSION: ET significantly improves exercise capacity and quality of life in both HFpEF and HFrEF patients. In HFpEF patients, ET significantly improved an important index of diastolic function, with significant improvements in LVEF and NTproBNP/BNP seen in HFrEF patients only. Such benefits did not translate into significantly reduced hospitalisation or mortality after short-term follow-up. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40798-022-00464-5.
format Online
Article
Text
id pubmed-9177931
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-91779312022-06-10 Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis Edwards, Jamie J. O’Driscoll, Jamie M. Sports Med Open Systematic Review BACKGROUND: While exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters. METHODS: A comprehensive systematic search was performed to identify trials published between 1990 and May 2021. Controlled trials of adults reporting pre- and post-ET peak VO2, 6-min walk distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) and left ventricular ejection fraction (LVEF) were considered. Parameters of cardiac diastolic function, brain natriuretic peptides (BNP)/N-terminal prohormone of BNP (NTproBNP) and follow-up hospitalisation and mortality data were also analysed. RESULTS: Ninety-three studies (11 HFpEF and 82 HFrEF) were included in the final analysis, with a pooled sample size of 11,081 participants. HFpEF analysis demonstrated significant improvements in peak VO2 (weighted mean difference: 2.333 ml·min(-1)·kg(-1), P(fixed) < 0.001), 6MWD (WMD: 35.396 m, P(fixed) < 0.001), MLHFQ (WMD: − 10.932, P(random) < 0.001), KCCQ (WMD: 3.709, P(fixed) = 0.037) and E/e′ (WMD: − 1.709, [95% CI] = − 2.91–0.51, P(random) = 0.005). HFrEF analysis demonstrated significant improvements in peak VO2 (WMD: 3.050 ml·min(-1)·kg(-1), P(random) < 0.001), 6MWD (WMD: 37.299 m, P(random) < 0.001), MLHFQ (WMD: − 10.932, P(random) < 0.001), LVEF (WMD: 2.677%, P(random) = 0.002) and BNP/NTproBNP (SMD: − 1.349, P(random) < 0.001). Outcome analysis was only performed in HFrEF, which found no significant changes in hospitalisation, all-cause mortality or composite end-points. CONCLUSION: ET significantly improves exercise capacity and quality of life in both HFpEF and HFrEF patients. In HFpEF patients, ET significantly improved an important index of diastolic function, with significant improvements in LVEF and NTproBNP/BNP seen in HFrEF patients only. Such benefits did not translate into significantly reduced hospitalisation or mortality after short-term follow-up. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40798-022-00464-5. Springer International Publishing 2022-06-08 /pmc/articles/PMC9177931/ /pubmed/35674912 http://dx.doi.org/10.1186/s40798-022-00464-5 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Systematic Review
Edwards, Jamie J.
O’Driscoll, Jamie M.
Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_full Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_fullStr Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_full_unstemmed Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_short Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
title_sort exercise training in heart failure with preserved and reduced ejection fraction: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177931/
https://www.ncbi.nlm.nih.gov/pubmed/35674912
http://dx.doi.org/10.1186/s40798-022-00464-5
work_keys_str_mv AT edwardsjamiej exercisetraininginheartfailurewithpreservedandreducedejectionfractionasystematicreviewandmetaanalysis
AT odriscolljamiem exercisetraininginheartfailurewithpreservedandreducedejectionfractionasystematicreviewandmetaanalysis