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

Ranu Baral, Brodie Loudon, Michael P. Frenneaux, Vassilios S. Vassiliou

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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.

Original languageEnglish
Pages (from-to)121-128
Number of pages8
JournalHeart & Lung
Issue number1
Early online date18 Jul 2020
Publication statusPublished - Jan 2021


  • Heart failure with preserved ejection fraction (HFpEF)
  • Systematic review
  • Ventricular-vascular coupling (VVC)

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