Exercise Training in Patients With HF and Preserved EF
Exercise Training in Patients With HF and Preserved EF
Background Heart failure with preserved ejection fraction (HFpEF) is a disease of the elderly with cardiovascular stiffening and reduced exercise capacity. Exercise training appears to improve exercise capacity and cardiovascular function in heart failure with reduced ejection fraction. However, it is unclear whether exercise training could improve cardiovascular stiffness, exercise capacity, and ventricular-arterial coupling in HFpEF.
Methods Eleven HFpEF patients and 13 healthy controls underwent invasive measurements with right heart catheterization to define Starling and left ventricular (LV) pressure-volume curves; secondary functional outcomes included Doppler echocardiography, arterial stiffness, cardiopulmonary exercise testing with cardiac output measurement, and ventricular-arterial coupling assessed by the dynamic Starling mechanism. Seven of 11 HFpEF patients (74.9 ± 6 years; 3 men/4 women) completed 1 year of endurance training followed by repeat measurements. Pulmonary capillary wedge pressures and LV end-diastolic volumes were measured at baseline during decreased and increased cardiac filling. LV compliance was assessed by the slope of the pressure-volume curve. Beat-to-beat LV end-diastolic pressure (estimated from pulmonary arterial diastolic pressure) and stroke volume index were obtained, and spectral transfer function analysis was used to assess the dynamic Starling mechanism.
Results Before training, HFpEF patients had reduced exercise capacity, distensibility and dynamic Starling mechanism but similar LV compliance and end-diastolic volumes compared to controls albeit with elevated filling pressure and increased wall stress. One year of training had little effect on LV compliance and volumes, arterial stiffness, exercise capacity or ventricular-arterial coupling.
Conclusion Contrary to our hypothesis, 1 year of endurance training failed to impart favorable effects on cardiovascular stiffness or function in HFpEF.
About half of patients >65 years old admitted with congestive heart failure have a "preserved" ejection fraction (HFpEF). HFpEF patients are characterized by a reduced exercise capacity and increased morbidity and mortality similar to those with systolic HF. Impaired LV diastolic function has been thought to be the primary cause of HF in HFpEF patients, who are more likely to be elderly, with hypertension and diabetes mellitus. So far, no drug therapy has improved LV lusitropic properties or exercise capacity in HFpEF patients.
Life-long endurance exercise training prevents age-associated declines of exercise capacity and cardiac compliance in healthy subjects. Moreover, several months to a year of exercise training increases exercise capacity in healthy subjects and heart failure patients with reduced ejection fraction (HFrEF). An improved exercise capacity in HFrEF appears to be related to improvements in peripheral arterial function. In HFpEF patients, there are some studies in which exercise capacity was apparently improved after several months of exercise training with or without improved LV diastolic function. However, it is unclear whether and how exercise training could improve LV and arterial function, exercise capacity, or peripheral oxygen extraction in HFpEF patients.
We recently reported characterization of static and dynamic LV diastolic function and LV-arterial coupling by use of invasive measurements in HFpEF patients. In the present study, we prescribed one year of progressive exercise training for these same patients and repeated a comprehensive and detailed measurement of hemodynamics and LV structure and function. Therefore, these data would be of importance to develop strategies that may improve LV and arterial function, and exercise capacity and eventually reduce adverse outcomes in HFpEF patients.
Abstract and Introduction
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is a disease of the elderly with cardiovascular stiffening and reduced exercise capacity. Exercise training appears to improve exercise capacity and cardiovascular function in heart failure with reduced ejection fraction. However, it is unclear whether exercise training could improve cardiovascular stiffness, exercise capacity, and ventricular-arterial coupling in HFpEF.
Methods Eleven HFpEF patients and 13 healthy controls underwent invasive measurements with right heart catheterization to define Starling and left ventricular (LV) pressure-volume curves; secondary functional outcomes included Doppler echocardiography, arterial stiffness, cardiopulmonary exercise testing with cardiac output measurement, and ventricular-arterial coupling assessed by the dynamic Starling mechanism. Seven of 11 HFpEF patients (74.9 ± 6 years; 3 men/4 women) completed 1 year of endurance training followed by repeat measurements. Pulmonary capillary wedge pressures and LV end-diastolic volumes were measured at baseline during decreased and increased cardiac filling. LV compliance was assessed by the slope of the pressure-volume curve. Beat-to-beat LV end-diastolic pressure (estimated from pulmonary arterial diastolic pressure) and stroke volume index were obtained, and spectral transfer function analysis was used to assess the dynamic Starling mechanism.
Results Before training, HFpEF patients had reduced exercise capacity, distensibility and dynamic Starling mechanism but similar LV compliance and end-diastolic volumes compared to controls albeit with elevated filling pressure and increased wall stress. One year of training had little effect on LV compliance and volumes, arterial stiffness, exercise capacity or ventricular-arterial coupling.
Conclusion Contrary to our hypothesis, 1 year of endurance training failed to impart favorable effects on cardiovascular stiffness or function in HFpEF.
Introduction
About half of patients >65 years old admitted with congestive heart failure have a "preserved" ejection fraction (HFpEF). HFpEF patients are characterized by a reduced exercise capacity and increased morbidity and mortality similar to those with systolic HF. Impaired LV diastolic function has been thought to be the primary cause of HF in HFpEF patients, who are more likely to be elderly, with hypertension and diabetes mellitus. So far, no drug therapy has improved LV lusitropic properties or exercise capacity in HFpEF patients.
Life-long endurance exercise training prevents age-associated declines of exercise capacity and cardiac compliance in healthy subjects. Moreover, several months to a year of exercise training increases exercise capacity in healthy subjects and heart failure patients with reduced ejection fraction (HFrEF). An improved exercise capacity in HFrEF appears to be related to improvements in peripheral arterial function. In HFpEF patients, there are some studies in which exercise capacity was apparently improved after several months of exercise training with or without improved LV diastolic function. However, it is unclear whether and how exercise training could improve LV and arterial function, exercise capacity, or peripheral oxygen extraction in HFpEF patients.
We recently reported characterization of static and dynamic LV diastolic function and LV-arterial coupling by use of invasive measurements in HFpEF patients. In the present study, we prescribed one year of progressive exercise training for these same patients and repeated a comprehensive and detailed measurement of hemodynamics and LV structure and function. Therefore, these data would be of importance to develop strategies that may improve LV and arterial function, and exercise capacity and eventually reduce adverse outcomes in HFpEF patients.
