AUTHOR=Bingel Anne , Messroghli Daniel , Weimar Andreas , Runte Kilian , Salcher-Konrad Maximilian , Kelle Sebastian , Pieske Burkert , Berger Felix , Kuehne Titus , Goubergrits Leonid , Fuerstenau Daniel , Kelm Marcus 

TITLE=Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Patients With Heart Failure: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.718114

DOI=10.3389/fcvm.2022.718114

ISSN=2297-055X

ABSTRACT=Although disease aetiologies differ, heart failure patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction both present with clinical symptoms when under stress and impaired exercise capacity. The extent to which the adaptation of heart rate (HR), stroke volume (SV) and cardiac output (CO) under stress conditions is altered can be quantified by stress testing in conjunction with imaging methods and may help to detect the diminishment in a patient's condition early. The aim of this meta-analysis was to quantify hemodynamic changes during physiologic and pharmacologic stress testing in patients with heart failure.

A systematic literature search (PROSPERO 2020:CRD42020161212) in MEDLINE was conducted to assess haemodynamic changes under dynamic and pharmacological stress testing at different stress intensities in HFpEF and HFrEF patients. Pooled mean changes were estimated using a random effects model. Altogether, 140 study arms with 7248 exercise tests were analysed. High intensity dynamic stress testing represented 73% of these data (70 study arms with 5318 exercise tests), where: HR increased by 45.69 bpm (95% CI 44.51-46.88; I2=98.4%), SV by 13.49 ml (95% CI 6.87-20.10; I2=68.5%), and CO by 3.41 l/min (95% CI 2.86-3.95; I2=86.3%). No significant differences between HFrEF and HFpEF groups were found. 

Despite limited availability of comparative studies, these reference values can help to estimate the expected haemodynamic responses in patients with heart failure. No differences in chronotropic reactions, changes in stroke volume, or cardiac output were found between HFrEF and HFpEF. When compared to healthy individuals, exercise tolerance, as well as associated heart rate and cardiac output changes under moderate-high dynamic stress, were substantially impaired in both heart failure groups. This may contribute to a better disease understanding, future study planning and patient-specific predictive models.