Abstract 1048: Chronic Heart Failure and Aging: Effects of Exercise Training on Left Ventricular Diastolic Dysfunction
BACKGROUND: Diastolic dysfunction (DD) may occur in both physiologic aging and chronic heart failure (CHF). It has, however, never been assessed, whether the degree of DD in CHF patients is age dependent and if potential beneficial effects of exercise training (ET) on diastolic function are diminished in old age.
METHODS: We randomized 60 pts. with stable CHF (age 62.4±1.7 yrs, EF 28.3±1.7%, VO2max 13.6±2.0ml/kg*min) and 60 healthy subjects (HS) (age 60.5±2.4 yrs, EF 60±1%, VO2max 21.1±3.1 ml/kg*min) to a training (T) or a control group (C). To detect possible aging effects we included subjects below 55 (y) and above 65 yrs. (o). 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 isovolumetric relaxation time (IVRT) and lateral E/É ratio were determined by echocardiography with tissue Doppler.
RESULTS: As compared to young HS, old HS showed at baseline an increased IVRT and an increased E/È ratio (y: IVRT 90±3 ms; E/È 7.2±0.1 o: IVRT 147±5ms; E/È 13.8±0.2; p<0.05). In CHF pts. diastolic function was impaired (y: IVRT161±5ms; E/È 14.9±0.5; o: IVRT 158±4ms; E/È 14.3±0.2) with no observable difference between y and o (p=0.72). As a result of ET, IVRT was reduced by 21±3% and E/È was reduced by 34±10% in old HS (p<0.05), while it remained unchanged in young training HS and C respectively. In y and o pts. with CHF four wks. of ET resulted in a significant change in IVRT (y: −29±4%; p<0.05; o: −26±2% p<0.05) and E/È (y: −33.5±2%; p<0,05; o: −35.2±3%; p<0.05). In C no effect was detectable. Strong inverse correlations were found between the reduction of E/E′ and the change of VO2max (HS o: r=−0.74; CHF y: r=−0.70; o: r=0.81; all p<0.05).
CONCLUSIONS: The present trial provides new insight into the age-dependency of cardiovascular ET effects: Among HS aging is associated with the development of diastolic dysfunction. In CHF both young and old pts. exhibit a similar degree of diastolic dysfunction. Four weeks of ET are effective in improving both active relaxation and passive compliance in old HS and in all age groups of CHF pts. This lusitropic ET effects were not significantly diminished among older pts. underlining the potentials of rehabilitation interventions in an age-group with a high prevalence of CHF.