Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug 1;22(1):345.
doi: 10.1186/s12872-022-02792-6.

Relationship of arterial tonometry and exercise in patients with chronic heart failure: a systematic review with meta-analysis and trial sequential analysis

Xiaodan Gong  1 , Mengwen Hu  2 , Mei Li  3
Affiliations
Meta-Analysis

Relationship of arterial tonometry and exercise in patients with chronic heart failure: a systematic review with meta-analysis and trial sequential analysis

Xiaodan Gong et al. BMC Cardiovasc Disord. .

Abstract

Background: Arterial stiffness is a common characteristic in patients with chronic heart failure (CHF), and arterial tonometric technologies related to arterial stiffness are novel and effective methods and have an important value in the diagnosis and prognosis of CHF. In terms of ameliorating arterial stiffness in patients with CHF, exercise training is considered an adjuvant treatment and also an effective means in the diagnosis and judgment of prognosis. However, there are huge controversies and inconsistencies in these aspects. The objective of this meta-analysis was to systematically test the connection of arterial tonometry and exercise in patients with CHF.

Methods: Databases, including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, were accessed from inception to 7 March 2022. The meta-analysis was then conducted, and trial sequential analysis (TSA) was performed jointly to further verify our tests and reach more convincing conclusions by using RevMan version 5.4 software, STATA version 16.0 software, and TSA version 0.9.5.10 Beta software.

Results: Eighteen articles were included, with a total of 876 participants satisfying the inclusion criteria. The pooling revealed that flow-mediated dilation (FMD) was lower in basal condition [standardized mean difference (SMD): - 2.28%, 95% confidence interval (CI) - 3.47 to - 1.08, P < 0.001] and improved significantly after exercise (SMD: 5.96%, 95% CI 2.81 to 9.05, P < 0.001) in patients with heart failure with reduced ejection fraction (HFrEF) compared with healthy participants. The high-intensity training exercise was more beneficial (SMD: 2.88%, 95% CI 1.78 to 3.97, P < 0.001) than the moderate-intensity training exercise to improve FMD in patients with CHF. For augmentation index (AIx), our study indicated no significant differences (SMD: 0.50%, 95% CI - 0.05 to 1.05, P = 0.074) in patients with heart failure with preserved ejection fraction (HFpEF) compared with healthy participants. However, other outcomes of our study were not identified after further verification using TSA, and more high-quality studies are needed to reach definitive conclusions in the future.

Conclusions: This review shows that FMD is lower in basal condition and improves significantly after exercise in patients with HFrEF compared with healthy population; high-intensity training exercise is more beneficial than moderate-intensity training exercise to improve FMD in patients with CHF; besides, there are no significant differences in AIx in patients with HFpEF compared with the healthy population. More high-quality studies on this topic are warranted.

Keywords: Arterial stiffness; Arterial tonometry; Chronic heart failure; Exercise; Meta-analysis.

PubMed Disclaimer

Conflict of interest statement

The authors declares that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for inclusion of studies in meta-analysis
Fig. 2
Fig. 2
Population characteristics of included studies comparing flow-mediated dilation and augmentation index in patients with chronic heart failure and healthy participants
Fig. 3
Fig. 3
Population characteristics of included studies involving flow-mediated dilation and exercises in patients with chronic heart failure
Fig. 4
Fig. 4
Forest plot of the subgroup analysis of flow-mediated dilation in patients with chronic heart failure and healthy participants based on different types of chronic heart failure. HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction
Fig. 5
Fig. 5
Forest plot of the subgroup analysis of flow-mediated dilation in patients with chronic heart failure in the exercise and non-exercise setting based on different types of chronic heart failure. HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction
Fig. 6
Fig. 6
Forest plot of the subgroup analysis of flow-mediated dilation in patients with chronic heart failure in the exercise and non-exercise setting based on different exercise intensities
Fig. 7
Fig. 7
Forest plot of flow-mediated dilation in patients with chronic heart failure in moderate intensity training exercise and high intensity training exercise setting
Fig. 8
Fig. 8
Forest plot of the subgroup analysis of augmentation index in patients with chronic heart failure and healthy participants based on different types of chronic heart failure. HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: part I: aging arteries: a "set up" for vascular disease. Circulation. 2003;107(1):139–146. doi: 10.1161/01.CIR.0000048892.83521.58. - DOI - PubMed
    1. Herrington DM, Fan L, Drum M, Riley WA, Pusser BE, Crouse JR, Burke GL, McBurnie MA, Morgan TM, Espeland MA. Brachial flow-mediated vasodilator responses in population-based research: methods, reproducibility and effects of age, gender and baseline diameter. J Cardiovasc Risk. 2001;8(5):319–328. doi: 10.1097/00043798-200110000-00012. - DOI - PubMed
    1. Donato AJ, Uberoi A, Wray DW, Nishiyama S, Lawrenson L, Richardson RS. Differential effects of aging on limb blood flow in humans. Am J Physiol Heart Circ Physiol. 2006;290(1):H272–278. doi: 10.1152/ajpheart.00405.2005. - DOI - PubMed
    1. Beere PA, Russell SD, Morey MC, Kitzman DW, Higginbotham MB. Aerobic exercise training can reverse age-related peripheral circulatory changes in healthy older men. Circulation. 1999;100(10):1085–1094. doi: 10.1161/01.CIR.100.10.1085. - DOI - PubMed
    1. Parker BA, Ridout SJ, Proctor DN. Age and flow-mediated dilation: a comparison of dilatory responsiveness in the brachial and popliteal arteries. Am J Physiol Heart Circ Physiol. 2006;291(6):H3043–3049. doi: 10.1152/ajpheart.00190.2006. - DOI - PubMed

Publication types