Skip to main content

Advertisement

SpringerLink
Log in

Meta-analysis addressing the impact of cardiovascular-acting medication on peak oxygen uptake of patients with HFpEF

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

As our therapeutic armamentarium for HFpEF is insufficient, research has been focusing on the potential beneficial effect of existing pharmaceutical regimens on this specific patient population. A series of RCTs have recently examined the impact of various pharmaceutical treatments with proven benefit in HFrEF, on the improvement of symptoms of HFpEF patients. This systematic review and meta-analysis comprised studies of adult patients with HFpEF and evaluated the impact of different cardiovascular acting medication on cardiorespiratory fitness, reflected by peak VO2 values measured during CPET. The primary outcome was difference between groups in the change of peak VO2 (ΔpeakVO2). Literature search involved PubMed/MEDLINE, Scopus and Web of Science databases. Our search identified 3634 records and 19 studies were included in qualitative analysis; 12 studies with 1341 patients were finally included in primary outcome analysis. ΔpeakVO2 between baseline and study-end did not significantly change after treatment with spironolactone, ivabradine, sildenafil, or oral inorganic nitrate and neither did difference in 6MWT distance after treatment with spironolactone. Spironolactone led to statistically significant reduction in E/E’ ratio study-end values (WMD − 1.64, 95%CI − 2.42 to − 0.86, I2 = 87%, p < 0.0001), as well as to a significant increase in MLHFQ values (WMD 0.75, 95%CI 0.02 to 1.48, I2 = 0%, p = 0.65), indicating deterioration in HRQoL among HFpEF patients. A series of established cardiovascular acting medication in HFrEF seems not to confer significant benefit in peak VO2 and 6MWT distance in HFpEF. Spironolactone is associated with improvements in diastolic function and with a significant deterioration in HRQoL of this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Availability of data and material

Not applicable.

Code availability

Not applicable.

References

  1. Bhuiyan T, Maurer MS (2011) Heart failure with preserved ejection fraction: persistent diagnosis, therapeutic enigma. Curr Cardiovasc Risk Rep 5(5):440–449

    Article  PubMed  PubMed Central  Google Scholar 

  2. McHugh K, DeVore AD, Wu J, Matsouaka RA, Fonarow GC, Heidenreich PA, Yancy CW, Green JB, Altman N, Hernandez AF (2019) Heart failure with preserved ejection fraction and diabetes: JACC state-of-the-art review. J Am Coll Cardiol 73(5):602–611

    Article  PubMed  Google Scholar 

  3. Kjeldsen SE, von Lueder TG, Smiseth OA, Wachtell K, Mistry N, Westheim AS, Hopper I, Julius S, Pitt B, Reid CM, Devereux RB, Zannad F (2020) Medical therapies for heart failure with preserved ejection fraction. Hypertension 75(1):23–32

    Article  CAS  PubMed  Google Scholar 

  4. Tromp J, Westenbrink BD, Ouwerkerk W, van Veldhuisen DJ, Samani NJ, Ponikowski P, Metra M, Anker SD, Cleland JG, Dickstein K, Filippatos G, van der Harst P, Lang CC, Ng LL, Zannad F, Zwinderman AH, Hillege HL, van der Meer P, Voors AA (2018) Identifying pathophysiological mechanisms in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 72(10):1081–1090

    Article  CAS  PubMed  Google Scholar 

  5. Tannenbaum S, Sayer GT (2015) Advances in the pathophysiology and treatment of heart failure with preserved ejection fraction. Curr Opin Cardiol 30(3):250–258

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dhakal BP, Malhotra R, Murphy RM, Pappagianopoulos PP, Baggish AL, Weiner RB, Houstis NE, Eisman AS, Hough SS, Lewis GD (2015) Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction. Circ Heart Fail 8(2):286–294

    Article  PubMed  Google Scholar 

  7. Tucker WJ, Nelson MD, Beaudry RI, Halle M, Sarma S, Kitzman DW, Gerche A, Haykowksy MJ (2016) Impact of exercise training on peak oxygen uptake and its determinants in heart failure with preserved ejection fraction. Card Fail Rev 2(2):95–101

    PubMed  PubMed Central  Google Scholar 

  8. Palau P, Domínguez E, Núñez E, Ramón JM, López L, Melero J, Sanchis J, Bellver A, Santas E, Bayes-Genis A, Chorro FJ, Núñez J (2018) Peak exercise oxygen uptake predicts recurrent admissions in heart failure with preserved ejection fraction. Rev Esp Cardiol (Engl Ed) 71(4):250–256

    Article  Google Scholar 

  9. Leggio M, Fusco A, Loreti C, Limongelli G, Bendini MG, Mazza A, Coraci D, Padua L (2020) Effects of exercise training in heart failure with preserved ejection fraction: an updated systematic literature review. Heart Fail Rev 25(5):703–711

    Article  CAS  PubMed  Google Scholar 

  10. Kitzman DW, Little WC, Brubaker PH, Anderson RT, Hundley WG, Marburger CT, Brosnihan B, Morgan TM, Stewart KP (2002) Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA 288(17):2144–2150

    Article  PubMed  Google Scholar 

  11. Marburger CT, Brubaker PH, Pollock WE, Morgan TM, Kitzman DW (1998) Reproducibility of cardiopulmonary exercise testing in elderly patients with congestive heart failure. Am J Cardiol 82(7):905–909

    Article  CAS  PubMed  Google Scholar 

  12. Ilieșiu AM, Hodorogea AS (2018) Treatment of heart failure with preserved ejection fraction. Adv Exp Med Biol 1067:67–87

    Article  PubMed  Google Scholar 

  13. Zamani P, Rawat D, Shiva-Kumar P, Geraci S, Bhuva R, Konda P, Doulias PT, Ischiropoulos H, Townsend RR, Margulies KB, Cappola TP, Poole DC, Chirinos JA (2015) Effect of inorganic nitrate on exercise capacity in heart failure with preserved ejection fraction. Circulation 131(4):371–80

  14. Borlaug BA, Anstrom KJ, Lewis GD, Shah SJ, Levine JA, Koepp GA, Givertz MM, Felker GM, LeWinter MM, Mann DL, Margulies KB, Smith AL, Tang WHW, Whellan DJ, Chen HH, Davila-Roman VG, McNulty S, Desvigne-Nickens P, Hernandez AF, Braunwald E, Redfield MM (2018) Effect of inorganic nitrite vs placebo on exercise capacity among patients with heart failure with preserved ejection fraction: the INDIE-HFpEF randomized clinical trial. JAMA 320(17):1764–1773

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Udelson JE, Lewis GD, Shah SJ, Zile MR, Redfield MM, Burnett J Jr, Parker J, Seferovic JP, Wilson P, Mittleman RS, Profy AT, Konstam MA (2020) Effect of praliciguat on peak rate of oxygen consumption in patients with heart failure with preserved ejection fraction: the CAPACITY HFpEF randomized clinical trial. JAMA 324(15):1522–1531

    Article  PubMed  PubMed Central  Google Scholar 

  16. Upadhya B, Hundley WG, Brubaker PH, Morgan TM, Stewart KP, Kitzman DW (2017) Effect of spironolactone on exercise tolerance and arterial function in older adults with heart failure with preserved ejection fraction. J Am Geriatr Soc 65(11):2374–2382

    Article  PubMed  PubMed Central  Google Scholar 

  17. Higgins JP, Sterne JAC, Savovic J, Page MJ, Hhróbjartsson A, Boutron I, Reeves B, Eldridge S (2016) A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev 10:29–31

    Google Scholar 

  18. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  19. Higgins JPTGS (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration

  20. Van Tassell BW, Arena R, Biondi-Zoccai G, McNair Canada J, Oddi C, Abouzaki NA, Jahangiri A, Falcao RA, Kontos MC, Shah KB, Voelkel NF, Dinarello CA, Abbate A (2014) Effects of interleukin-1 blockade with anakinra on aerobic exercise capacity in patients with heart failure and preserved ejection fraction (from the D-HART pilot study). Am J Cardiol 113(2):321–327

    Article  PubMed  Google Scholar 

  21. Van Tassell BW, Trankle CR, Canada JM, Carbone S, Buckley L, Kadariya D, Del Buono MG, Billingsley H, Wohlford G, Viscusi M, Oddi-Erdle C, Abouzaki NA, Dixon D, Biondi-Zoccai G, Arena R, Abbate A (2018) IL-1 blockade in patients with heart failure with preserved ejection fraction. Circ Heart Fail 11(8):e005036

  22. Nodari S, Metra M, Dei Cas L (2003) Beta-blocker treatment of patients with diastolic heart failure and arterial hypertension. A prospective, randomized, comparison of the long-term effects of atenolol vs. nebivolol. Eur J Heart Fail 5(5):621–7

  23. Kosmala W, Rojek A, Przewlocka-Kosmala M, Wright L, Mysiak A, Marwick TH (2016) Effect of aldosterone antagonism on exercise tolerance in heart failure with preserved ejection fraction. J Am Coll Cardiol 68(17):1823–1834

    Article  CAS  PubMed  Google Scholar 

  24. Kosmala W, Holland DJ, Rojek A, Wright L, Przewlocka-Kosmala M, Marwick TH (2013) Effect of I-f-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction. J Am Coll Cardiol 62(15):1330–1338

    Article  CAS  PubMed  Google Scholar 

  25. Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G, LeWinter MM, Rouleau JL, Bull DA, Mann DL, Deswal A, Stevenson LW, Givertz Elizabeth O Ofili MM, O'Connor CM, Felker GM, Goldsmith SR, Bart BA, McNulty SE, Ibarra JC, Lin G, Oh JK, Patel MR, Kim RJ, Tracy RP, Velazquez EJ, Anstrom KJ, Hernandez AF, Mascette AM, Braunwald E (2013) Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: A randomized clinical trial. JAMA 309(12):1268–77

  26. Pal N, Sivaswamy N, Mahmod M, Yavari A, Rudd A, Singh S, Dawson DK, Francis JM, Dwight JS, Watkins H, Neubauer S, Frenneaux M, Ashrafian H (2015) Effect of selective heart rate slowing in heart failure with preserved ejection fraction. Circulation 132(18):1719–1725

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Edelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, Duvinage A, Stahrenberg R, Durstewitz K, Loffler M, Dungen HD, Tschope C, Herrmann-Lingen C, Halle M, Hasenfuss G, Gelbrich G, Pieske B, Aldo DHFI (2013) Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction the Aldo-DHF randomized controlled trial. Jama-Journal of the American Medical Association 309(8):781–791

    Article  CAS  Google Scholar 

  28. Liu LCY, Hummel YM, van der Meer P, Berger RMF, Damman K, van Veldhuisen DJ, Voors AA, Hoendermis ES (2017) Effects of sildenafil on cardiac structure and function, cardiopulmonary exercise testing and health-related quality of life measures in heart failure patients with preserved ejection fraction and pulmonary hypertension. Eur J Heart Fail 19(1):116–125

    Article  CAS  PubMed  Google Scholar 

  29. Luca GDMD (2012) Ivabradine and diastolic heart failure. J Am Coll Cardiol 59(13 Supplement):E1009–E

  30. Eggebeen J, Kim-Shapiro DB, Haykowsky M, Morgan TM, Basu S, Brubaker P, Rejeski J, Kitzman DW (2016) One week of daily dosing with beetroot juice improves submaximal endurance and blood pressure in older patients with heart failure and preserved ejection fraction. JACC: Heart Failure 4(6):428–37

  31. Zamani P, Tan V, Soto-Calderon H, Beraun M, Brandimarto JA, Trieu L, Varakantam S, Doulias PT, Townsend RR, Chittams J, Margulies KB, Cappola TP, Poole DC, Ischiropoulos H, Chirinos JA (2017) Pharmacokinetics and pharmacodynamics of inorganic nitrate in heart failure with preserved ejection fraction. Circ Res 120(7):1151–1161

    Article  CAS  PubMed  Google Scholar 

  32. Kitzman DW, Hundley WG, Brubaker PH, Morgan TM, Moore JB, Stewart KP, Little WC (2010) Randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction. Circulation-Heart Failure 3(4):477–485

    Article  PubMed  PubMed Central  Google Scholar 

  33. Parthasarathy HK, Pieske B, Weisskopf M, Andrews CD, Brunel P, Struthers AD, MacDonald TM (2009) A randomized, double-blind, placebo-controlled study to determine the effects of valsartan on exercise time in patients with symptomatic heart failure with preserved ejection fraction. Eur J Heart Fail 11(10):980–989

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Maier LS, Layug B, Karwatowska-Prokopczuk E, Belardinelli L, Lee S, Sander J, Lang C, Wachter R, Edelmann F, Hasenfuss G, Jacobshagen C (2013) RAnoLazIne for the treatment of diastolic heart failure in patients with preserved ejection fraction. The RALI-DHF proof-of-concept study. JACC: Heart Failure 1(2):115–22

  35. Shantsila E, Shahid F, Sun Y, Deeks J, Calvert M, Fisher JP, Kirchhof P, Gill PS, Lip GYH (2020) Spironolactone in atrial fibrillation with preserved cardiac fraction: the IMPRESS-AF trial. J Am Heart Assoc 9(18):e016239

  36. Komajda M, Isnard R, Cohen-Solal A, Metra M, Pieske B, Ponikowski P, Voors AA, Dominjon F, Henon-Goburdhun C, Pannaux M, Böhm M (2017) Effect of ivabradine in patients with heart failure with preserved ejection fraction: the EDIFY randomized placebo-controlled trial. Eur J Heart Fail 19(11):1495–1503

    Article  CAS  PubMed  Google Scholar 

  37. Koroma TR, Samura SK, Cheng Y, Tang M (2020) Effect of ivabradine on left ventricular diastolic function, exercise tolerance and quality of life in patients with heart failure: a systemic review and meta-analysis of randomized controlled trials. Cardiol Res 11(1):40–49

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nadeem M, Hassib M, Aslam HM, Fatima D, Illahi Y (2020) Role of ivabradine in patients with heart failure with preserved ejection fraction. Cureus 12(2):e7123

  39. Gammone MA, Riccioni G, D’Orazio N (2020) Ivabradine: a new frontier in the treatment of stable coronary artery disease and chronic heart failure. Clin Ter 171(5):e449–e453

    CAS  PubMed  Google Scholar 

  40. Adamyan KG, Chilingaryan AL, Tumasyan LR, Tunyan LG (2013) Comparative efficacy of resistance and aerobic training on functional status and cardiac parameters in hypertensive patients with diastolic heart failure with preserved ejection fraction. Eur Heart J 34:184

    Article  Google Scholar 

  41. Donelli da Silveira A, Beust de Lima J, da Silva Piardi D, Dos Santos Macedo D, Zanini M, Nery R, Laukkanen JA, Stein R (2020) High-intensity interval training is effective and superior to moderate continuous training in patients with heart failure with preserved ejection fraction: a randomized clinical trial. Eur J Prev Cardiol 27(16):1733–43

  42. Haykowsky M, Brubaker P, Kitzman D (2012) Role of physical training in heart failure with preserved ejection fraction. Curr Heart Fail Rep 9(2):101–106

    Article  PubMed  PubMed Central  Google Scholar 

  43. Haykowsky MJ, Daniel KM, Bhella PS, Sarma S, Kitzman DW (2016) Heart failure: exercise-based cardiac rehabilitation: who, when, and how intense? Can J Cardiol 32(10):S382–S387

    Article  PubMed  Google Scholar 

  44. Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, Abdelhamed A, Haykowsky MJ (2013) Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol 62(7):584–592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Albouaini K, Egred M, Alahmar A, Wright DJ (2007) Cardiopulmonary exercise testing and its application. Postgrad Med J 83(985):675–682

    Article  PubMed  PubMed Central  Google Scholar 

  46. Herdy AH, Ritt LE, Stein R, Araújo CG, Milani M, Meneghelo RS, Ferraz AS, Hossri C, Almeida AE, Fernandes-Silva MM, Serra SM (2016) Cardiopulmonary exercise test: background, applicability and interpretation. Arq Bras Cardiol 107(5):467–481

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Berry JD, Pandey A, Gao A, Leonard D, Farzaneh-Far R, Ayers C, DeFina L, Willis B (2013) Physical fitness and risk for heart failure and coronary artery disease. Circ Heart Fail 6(4):627–634

    Article  PubMed  PubMed Central  Google Scholar 

  48. De Vecchis R, Ariano C (2017) Aldosterone receptor antagonists decrease mortality and cardiovascular hospitalizations in chronic heart failure with reduced left ventricular ejection fraction, but not in chronic heart failure with preserved left ventricular ejection fraction: a meta-analysis of randomized controlled trials. Minerva Cardioangiol 65(4):427–442

    Google Scholar 

  49. Kapelios CJ, Murrow JR, Nührenberg TG, Montoro Lopez MN (2019) Effect of mineralocorticoid receptor antagonists on cardiac function in patients with heart failure and preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 24(3):367–377

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Pandey A, Garg S, Matulevicius SA, Shah AM, Garg J, Drazner MH, Amin A, Berry JD, Marwick TH, Marso SP, de Lemos JA, Kumbhani DJ (2015) Effect of mineralocorticoid receptor antagonists on cardiac structure and function in patients with diastolic dysfunction and heart failure with preserved ejection fraction: a meta-analysis and systematic review. J Am Heart Assoc 4(10)

  51. Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N (2019) Effects of mineralocorticoid receptor antagonists on left ventricular diastolic function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Vessels 34(4):597–606

    Article  PubMed  Google Scholar 

  52. Xiang Y, Shi W, Li Z, Yang Y, Wang SY, Xiang R, Feng P, Wen L, Huang W (2019) Efficacy and safety of spironolactone in the heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction: a meta-analysis of randomized clinical trials. Medicine (United States) 98(13)

  53. Le HH, El-Khatib C, Mombled M, Guitarian F, Al Gobari M, Fall M, Janiaud P, Marchant I, Cucherat M, Bejan-Angoulvant T, Gueyffier F (2016) Impact of aldosterone antagonists on sudden cardiac death prevention in heart failure and post-myocardial infarction patients: a systematic review and meta analysis of randomized controlled trials. PLoS One 11(2)

  54. Li X, Qi Y, Li Y, Zhang S, Guo S, Chu S, Gao P, Zhu D, Wu Z, Lu L, Shen W, Jia N, Niu W (2013) Impact of mineralocorticoid receptor antagonists on changes in cardiac structure and function of left ventricular dysfunction a meta-analysis of randomized controlled trials. Circ Heart Fail 6(2):156–65

  55. Chen Y, Wang H, Lu Y, Huang X, Liao Y, Bin J (2015) Effects of mineralocorticoid receptor antagonists in patients with preserved ejection fraction: a meta-analysis of randomized clinical trials. BMC Medicine 13(1)

  56. Conceição LSR, Gois C, Fernandes RES, Souza DS, Júnior MBG, Carvalho VO (2021) Effect of ivabradine on exercise capacity in individuals with heart failure with preserved ejection fraction. Heart Fail Rev 26(1):157–163

    Article  PubMed  Google Scholar 

  57. Gui YJ, Chen JY, Hu JH, Ouyang MZ, Deng LM, Liu LL, Sun KJ, Tang Y, Xiang QY, Xu J, Zhu LY, Peng ZF, Zou P, Li B, Zheng ZF, Xu DY (2020) Efficacy and safety of inorganic nitrate versus placebo treatment in heart failure with preserved ejection fraction. cardiovascular drugs and therapy. 34(4):503–13

  58. Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, Brunner–La Rocca H-P, Choi D-J, Chopra V, Chuquiure-Valenzuela E, Giannetti N, Gomez-Mesa JE, Janssens S, Januzzi JL, Gonzalez-Juanatey JR, Merkely B, Nicholls SJ, Perrone SV, Piña IL, Ponikowski P, Senni M, Sim D, Spinar J, Squire I, Taddei S, Tsutsui H, Verma S, Vinereanu D, Zhang J, Carson P, Lam CSP, Marx N, Zeller C, Sattar N, Jamal W, Schnaidt S, Schnee JM, Brueckmann M, Pocock SJ, Zannad F, Packer M (2021) Empagliflozin in heart failure with a preserved ejection fraction. NEJM 385(16):1451–61

  59. Solomon SD, McMurray JJV, Anand IS, Ge J, Lam CSP, Maggioni AP, Martinez F, Packer M, Pfeffer MA, Pieske B, Redfield MM, Rouleau JL, van Veldhuisen DJ, Zannad F, Zile MR, Desai AS, Claggett B, Jhund PS, Boytsov SA, Comin-Colet J, Cleland J, Düngen H-D, Goncalvesova E, Katova T, Kerr Saraiva JF, Lelonek M, Merkely B, Senni M, Shah SJ, Zhou J, Rizkala AR, Gong J, Shi VC, Lefkowitz MP (2019) Angiotensin–neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med 381(17):1609–1620

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49 Str, 54645, Thessaloniki, Greece

    Aristi Boulmpou, Christodoulos E. Papadopoulos & Vassilios Vassilikos

  2. Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Marieta P. Theodorakopoulou, Maria-Eleni Alexandrou, Eva Pella & Pantelis Sarafidis

  3. Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece

    Afroditi K. Boutou

Authors
  1. Aristi Boulmpou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marieta P. Theodorakopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria-Eleni Alexandrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Afroditi K. Boutou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christodoulos E. Papadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eva Pella
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pantelis Sarafidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vassilios Vassilikos
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Aristi Boulmpou and Pantelis Sarafidis conceived of the presented idea. Aristi Boulmpou, Marieta P. Theodorakopoulou, and Maria-Eleni Alexandrou performed the literature search and conducted the statistical analysis. Aristi Boulmpou, Marieta P. Theodorakopoulou, Eva Pella, and Afroditi K. Boutou created the initial and final form of the present manuscript. Christodoulos E. Papadopoulos, Pantelis Sarafidis, and Vassilios Vassilikos supervised the process and critically revised the work. All authors read and approved the final form of the manuscript.

Corresponding author

Correspondence to Christodoulos E. Papadopoulos.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 299 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boulmpou, A., Theodorakopoulou, M.P., Alexandrou, ME. et al. Meta-analysis addressing the impact of cardiovascular-acting medication on peak oxygen uptake of patients with HFpEF. Heart Fail Rev 27, 609–623 (2022). https://doi.org/10.1007/s10741-021-10207-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-021-10207-5

Keywords

Search

Navigation