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

Abstract

Although disease etiologies differ, heart failure patients with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) 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 physiological and pharmacological stress testing in patients with HF. A systematic literature search (PROSPERO 2020:CRD42020161212) in MEDLINE was conducted to assess hemodynamic 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 7,248 exercise tests were analyzed. High-intensity dynamic stress testing represented 73% of these data (70 study arms with 5,318 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 the limited availability of comparative studies, these reference values can help to estimate the expected hemodynamic responses in patients with HF. No differences in chronotropic reactions, changes in SV, or CO were found between HFrEF and HFpEF. When compared to healthy individuals, exercise tolerance, as well as associated HR and CO changes under moderate-high dynamic stress, was substantially impaired in both HF groups. This may contribute to a better disease understanding, future study planning, and patient-specific predictive models.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020161212].

Assessment of Force Through Lactate as a Measure to Quantify the Training Load in Populations With Risk Factors

“…(Heidenreich et al, 2022). Este parámetro y su cuantificación es el primer paso en la programación y prescripción del entrenamiento (Bingel et al, 2022). Sin embargo, a nivel internacional no existe un consenso principalmente en las recomendaciones de intensidad de ejercicio ya que varían considerablemente entre países, reportando beneficios con diferentes métodos he intensidades desde ligera, moderada y alta intensidad.…”

“…(Shaw et al, 2022). Los objetivos difieren particularmente sin embargo los efectos del entrenamiento de fuerza cuando se incorpora a un programa integral de acondicionamiento físico son múltiples y sistémicos, reduce los factores de riesgo asociados con la enfermedad coronaria, la diabetes no insulinodependiente y el cáncer de colon , previene la osteoporosis, promueve la pérdida y el mantenimiento del peso, mejora la estabilidad dinámica y preserva la capacidad funcional y favorece el bienestar psicológico ( Anderson et al, 2016;Bingel et al, 2022;Gan et al, 2018). Estos beneficios pueden obtenerse con seguridad cuando se prescribe un programa individualizado (Caruso et al, 2016).…”

Guía mexicana de práctica clínica para el diagnóstico y el tratamiento de la insuficiencia cardiaca

“…Una RS publicada por Bingel et al publicada en 2022 44 tuvo como objetivo evaluar los cambios hemodinámicos durante estrés fisiológico y farmacológico en pacientes con insuficiencia cardiaca. Se analizaron 140 brazos de estudios y 7,248 pruebas durante el ejercicio y los resultados mostraron que no hubo diferencias en los parámetros entre pacientes ICFEr y ICFEp pero sí cuando se comparan con controles sanos 44 .…”

Clinical and Prognostic Value of Exaggerated Blood Pressure Response to Exercise

“…In both normotensive and hypertensive individuals, physical exercise, either dynamic or isometric, carried out in the clinical setting for cardiovascular (CV) diagnostics, is associated to significant blood pressure (BP) variations, in particular sharp increments in systolic BP (SBP) and variable changes in diastolic BP (DBP), that may either decrease, increase or remain unchanged [ 1 , 2 ]. In physiological conditions, BP changes during exercise are the result of the rise in cardiac output in response to the increased oxygen demand from working muscles via activation of the adrenergic tone [ 3 , 4 ]. The electrocardiography (ECG)-monitored stress test for assessing cardiopulmonary fitness is routinely performed by means of dynamic exercise with a progressive workload.…”