Abstract 3199: Diastolic Dysfunction in Chronic Heart Failure and Aging - Effects of Exercise Training
BACKGROUND: Diastolic left ventricular dysfunction may occur in both physiologic aging and chronic heart failure (CHF). It has, however, never been assessed, whether the degree of diastolic impairment in CHF is influenced by age and if the previously observed beneficial effects of exercise (ET) on left ventricular filling are diminished in old age.
METHODS: In this study we randomised 53 pts. with stable CHF(LVEF 27.3±2.1%) and 51 healthy subjects (HS) (LVEF 61.5±2.7%) to a training (T) or a control group (C). To detect possible aging effects we included subjects <55 (young) and >65 years (old). Subjects in the T-group exercised 4 times daily at 60 to 70% of VO2max for 4 weeks under supervision. At baseline and after the intervention E/A ratio and lateral E/E′ ratio were determined by echocardiography and with tissue Doppler imaging.
RESULTS: As compared to young HS, old HS showed at baseline a reduced E/A ratio and an increased E/È ratio (young: E/A 1.2±0.2; E/È 7.3±0.1 old: E/A 0.7±0.1; E/È 13.5±0.3; p<0.05). In CHF pts., diastolic function was impaired (young E/A 0.8±0.2; E/È 12.9±0.5 old: E/A 0.8±0.1; E/È 13.7±0.4). No difference of these baseline parameters between the age groups was observed (p=0.72). As a result of ET, E/A ratio improved from 0.7±0.1 to 1.2±0.2 and E/È ratio improved from 13.7±0.3 to 9.3±0.4 in old HS (p<0.05), while it remained unchanged in young training HS and C. In young and old pts. with CHF four weeks of ET resulted in a significant change in E/A ratio (young: from 0.8±0.1 to 1.2±0.1; p<0.05; old: from 0.7±0.1 to 1.1±0.2 p<0.05) and E/È ratio (young: from 13.1±0.3 to 10.1±0.2; p<0,05; old: from 14.1±0.3 to 11.2±0.3; p<0.05). In C no effect was detectable.
CONCLUSIONS: The present trial provides new insight into chronobiology of cardiovascular training effects: Among HS aging is associated with the development of significant left ventricular diastolic dysfunction. In CHF both young and old pts. exhibit a similar degree of LV-dysfunction. Four weeks of ET are effective in improving diastolic function in old HS and in young and old CHF pts. The lusitropic training effects were not significantly diminished among older pts. underlining the potentials of rehabilitation interventions in this patient group.