Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction
08 January 2019 (online)
Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).
The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.
This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.
Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).
Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.
- 1 Hamdani N, Paulus WJ. Treatment of heart failure with normal ejection fraction. Curr Treat Options Cardiovasc Med 2011; 13 (01) 26-34
- 2 Owan TE, Hodge DO, Herges RM. , et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355 (03) 251-259
- 3 Paulus WJ, van Ballegoij JJ. Treatment of heart failure with normal ejection fraction: an inconvenient truth!. J Am Coll Cardiol 2010; 55 (06) 526-537
- 4 Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 2002; 105 (11) 1387-1393
- 5 Dickstein K, Cohen-Solal A, Filippatos G. , et al; ESC Committee for Practice Guidelines (CPG). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10 (10) 933-989
- 6 Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 2011; 32 (06) 670-679
- 7 European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998; 19 (07) 990-1003
- 8 Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 2000; 101 (17) 2118-2121
- 9 Gorcsan III J, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 2011; 58 (14) 1401-1413
- 10 Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart 2010; 96 (24) 2032-2040
- 11 McMurray JJV, Adamopoulos S, Anker SD. , et al; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33 (14) 1787-1847
- 12 ACSM. Guidelines for Exercise Testing and Prescription. 8. Philadelphia: Lippincott William & Wilkins; 2010
- 13 American Thoracic Society. ATS statement: guidelines for the six-minute walk test. This Official Statement of the American Thoracic Society was approved by the ATS Board of Directors March 2002. Am J Respir Crit Care Med 2002; 166: 111-117
- 14 Bilbao A, Escobar A, García-Perez L, Navarro G, Quirós R. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes 2016; 14: 23
- 15 Cacciapuoti F, Scognamiglio A, Paoli VD, Romano C, Cacciapuoti F. Left atrial volume index as indicator of left ventricular diastolic dysfunction: comparation between left atrial volume index and tissue myocardial performance index. J Cardiovasc Ultrasound 2012; 20 (01) 25-29
- 16 Munagala VK, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Association of newer diastolic function parameters with age in healthy subjects: a population-based study. J Am Soc Echocardiogr 2003; 16 (10) 1049-1056
- 17 Pearson MJ, Mungovan SF, Smart NA. Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2017; 22 (02) 229-242
- 18 Edelmann F, Gelbrich G, Düngen HD. , et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 2011; 58 (17) 1780-1791
- 19 Tamura H, Watanabe T, Nishiyama S. , et al. Increased left atrial volume index predicts a poor prognosis in patients with heart failure. J Card Fail 2011; 17 (03) 210-216
- 20 Russo C, Sera F, Jin Z. , et al. Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: a population-based cohort study. Eur J Heart Fail 2016; 18 (05) 537-544
- 21 Edwards NC, Moody WE, Yuan M. , et al. Quantification of left ventricular interstitial fibrosis in asymptomatic chronic primary degenerative mitral regurgitation. Circ Cardiovasc Imaging 2014; 7 (06) 946-953
- 22 Kamperidis V, Marsan NA, Delgado V, Bax JJ. Left ventricular systolic function assessment in secondary mitral regurgitation: left ventricular ejection fraction vs. speckle tracking global longitudinal strain. Eur Heart J 2016; 37 (10) 811-816
- 23 Kasner M, Gaub R, Sinning D. , et al. Global strain rate imaging for the estimation of diastolic function in HFNEF compared with pressure-volume loop analysis. Eur J Echocardiogr 2010; 11 (09) 743-751
- 24 Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100 (21) 1673-1680
- 25 Russo C, Jin Z, Elkind MS. , et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail 2014; 16 (12) 1301-1309
- 26 Tops LF, Delgado V, Marsan NA, Bax JJ. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail 2017; 19 (03) 307-313
- 27 Bowen TS, Rolim NPL, Fischer T. , et al; Optimex Study Group. Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle. Eur J Heart Fail 2015; 17 (03) 263-272
- 28 Nunes RB, Alves JP, Kessler LP, Dal Lago P. Aerobic exercise improves the inflammatory profile correlated with cardiac remodeling and function in chronic heart failure rats. Clinics (São Paulo) 2013; 68 (06) 876-882
- 29 Wu SF. Rapid screening of psychological well-being of patients with chronic illness: reliability and validity test on WHO-5 and PHQ-9 scales. Depress Res Treat 2014; 2014: 239490
- 30 Evangelista LS, Cacciata M, Stromberg A, Dracup K. Dose-response relationship between exercise intensity, mood states, and quality of life in patients with heart failure. J Cardiovasc Nurs 2017; 32 (06) 530-537
- 31 Nolte K, Herrmann-Lingen C, Wachter R. , et al. Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the Ex-DHF-P trial. Eur J Prev Cardiol 2015; 22 (05) 582-593
- 32 Isaksen K, Munk PS, Giske R, Larsen AI. Effects of aerobic interval training on measures of anxiety, depression and quality of life in patients with ischaemic heart failure and an implantable cardioverter defibrillator: a prospective non-randomized trial. J Rehabil Med 2016; 48 (03) 300-306
- 33 Smart NA, Haluska B, Jeffriess L, Leung D. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail 2012; 18 (06) 295-301