Abstract 16343: Exercise-Induced Improvements in Heart Failure With Preserved Ejection Fraction Correlate With Improved Diastolic Function, but Unchanged Chronotropic Competence - The Ex-DHF-P Trial
Background: Patients with heart failure and preserved ejection fraction (HFPEF) frequently suffer from diastolic dysfunction. However, other mechanisms, e. g. chronotropic incompentence (CI) are also present and may promote heart failure symptoms, e.g. dyspnea on exertion.
Materials and methods: In the Ex-DHF-P trial, 64 patients with HFPEF were randomly assigned to a 3 month 3 times/week exercise endurance/strength training (n=44) or usual care (control, n=20)). Diastolic function was assessed by the E/e' ratio (pw-Doppler early diastolic velocity to tissue Doppler early diastolic velocity), chronotropic competence by the peak heart ratio/estimated peak heart ratio (HRR). Chronotropic incompetence (CI) was defined as a HRR < 0.80 in patients not receiving betablockers or a HRR < 0.62 in patients receiving betablockers.
Results: Training significantly improved exercise capacity (peak VO2 from 16.1 ± 4.9 (baseline) to 18.7 ± 5.4 ml/kg/min (follow-up, p<0.001) vs. 16.7 ± 4.7 (baseline) to 16.0 ± 6.0 (follow-up) ml/kg/min in the control group (p<0.001 vs. training). Training led to an improvement in diastolic function (E/e' decreased from 12.8±3.2 to 10.5±2.5; p<0.001, in the training group, but did not change in the control group (13.5±4.6 to 14.1±3.9 (followup); n.s., p<0.001 vs. training). 14 out of 64 patients had CI. HRR did not change in the training (0.83 ± 0.13 to 0.86 ± 0.12, p=n.s.) or control group (0.79 ± 0.13 to 0.79 ± 0.12, p=n.s.). Exercise capacity in patients with HFPEF increased, regardless of chronotropic competence.
Conclusion: Improved exercise capacity in HFPEF is associated with improved diastolic function, but not improved chronotropic competence. These results support the concept of treating diastolic dysfunction to improve symptoms in patients with HFPEF.
- © 2011 by American Heart Association, Inc.