Ventricular-vascular coupling in heart failure with preserved ejection fraction: A systematic review and meta-analysis

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex disease underlined by impaired ventricular-vascular coupling (VVC). Objectives: To evaluate the VVC ratio in HFpEF patients at rest and during exercise and compare it to the healthy and heart failure with reduced ejection fraction (HFrEF) controls. Methods: PubMed and EMBASE databases were searched for trials that matched the inclusion criteria. Random-effects models were used to estimate the pooled mean difference with 95% confidence interval using Open Meta[Analyst] software. Results: A total of 13 trials met the inclusion criteria. Although VVC ratio was comparable between HFpEF and healthy controls at rest, it was significantly lower in HFrEF compared to HFpEF. During exercise, there was a significant decline in VVC ratio in HFpEF (-0.119, 95% CI (-0.183 to -0.055), p<0.001). Conclusion: VVC ratio, although ‘preserved’ at rest in HFpEF patients, was overtly impaired during exercise highlighting the importance of dynamic testing.