Abstract 19326: Impact of Underlying Diseases on the Effect of Exercise Training in Patients with Chronic Heart Failure
Background: Although exercise training (ET) has been reported to improve exercise capacity in patients with chronic heart failure (CHF), the impact of underlying diseases on the effects of ET remains unknown.
Methods: A total of 137 CHF patients who participated in a 3-month ET program and underwent cardiopulmonary exercise testing were studied. The ET program consisted of supervised exercise sessions (walking, bicycle ergometer and calisthenics) combined with home exercise at an intensity of 40-60% heart rate reserve 3-5 times a week for 3 months. Exercise capacity by symptom-limited cardiopulmonary exercise testing and plasma BNP levels were measured at the beginning and the end of the program. They were divided into 4 groups according to underlying diseases: dilated cardiomyopathy (DCM, n=83), old myocardial infarction (OMI, n=47), hypertensive heart disease (HHD, n=9), and miscellaneous (MISC, n=8; hypertrophic cardiomyopathy [HCM] 2, dilated HCM 3, cardiac sarcoidosis 3). Patients with left ventricular support device were excluded.
Results: At baseline, there were no significant differences in left ventricular ejection fraction (LVEF; DCM 25% vs OMI 26% vs HHD 29% vs MISC 32%, NS) or peak oxygen uptake (% predict PVO2; 61% vs 60% vs 65% vs 62%, NS) among 4 groups. Prescribed exercise intensity and the number of session attendance were not significantly different among groups. However, after the 3-month ET, PVO2 significantly increased in the former three groups (61 to 68%, 60 to 63%, 65 to 78%, all p<0.05), but not in MISC group (62 to 60%, NS). In addition, the magnitudes of the increase in PVO2 (%ΔPVO2; +15% vs +9% vs +20% vs -3%) were variable among the groups; i.e., significantly smaller in MISC Group (p<0.05) and tended to be greater in HHD group (p<0.1) than in other groups. By logistic regression analysis, only underlying diseases, and not other factors such as age, BMI, baseline LVEF, BNP, or exercise session attendance predicted %ΔPVO2. Similar trends were observed in the changes in plasma BNP levels.
Conclusion: CHF patients due to HCM, d-HCM and sarcoidosis may be poor responders to ET, and in contrast, those due to HHD could be good responders. Thus, etiological consideration is important in predicting efficacy of ET for CHF.
- © 2010 by American Heart Association, Inc.