Abstract 15023: The Effects of Respiratory Muscle Trainings on Pneumonia Frequency and Fibrosis Process in Patients With Severe Heart Failure
Purpose: To study the effect of Respiratory Muscle Trainings (RMT) on pneumonia and hospitalization frequency in patients with III-IV NYHA class HF and its possible mechanisms.
Methods: 87 patients 63.4±3.8years old with NYHA III-IV HF were randomized to either an exercise training group (TG) (44pts) or to a control group (CG). The TG participated additionally in a RMT with gradual increase of inspire and expire resistance, 1-2 times a day for 20-25 min. VO2 peak, maximal inspiratory mouth pressure (PImax), vital capacity (VC) and forced vital capacity (FVC), plasmatic level of carboxyterminal propeptide of human type I procollagen (PIP) and the frequency of hospitalizations and lethal outcomes were evaluated at baseline and every 12 weeks during 1 year.
Results: RMT in the patients with severe HF significantly increased physical capacity (VO2 peak at baseline 9.46 ± 3.52 ml/kg/min in TG vs 9.38±4.06 ml/kg/min in CG, p>0.05; 11.98±2.98 ml/kg/min in TG vs 7.91 ± 1.96 ml/kg/min in CG, p<0.05, in 12 months), enhanced ventilation (VC at baseline 52.6± 4.3% in TG vs 52.5±4.7% in CG; 58.1±1.2% vs 52.2±3.3% p<0.05, in 12 months; FVC 44.2±2.1% vs 43.8±1.3% at baseline; 47.5±2.8% in TG vs 42.1±2.3% in CG, p<0.05, in 12 months). There was a regression in collagen synthesis (PIP 63.8±5.6 mcg/l in TG vs 63.4±5.7 mcg/l, p>0.05 at baseline; 68.7±7.6 mcg/l in EG vs 103.6±10.1 mcg/l in CG, p<0.05). TG showed a statistically significant increase in PImax in most of the patients (median PImax 6.5 in both groups [25th-75th percentile range 6.3-6.8 in TG vs 25th-75th percentile range 6.2-6.8 in CG at baseline, p=0.7], after 12 months median PI max, 7.1 in TG [25th-75th percentile range 6.8-7.2] vs median PI max 6.4 [25th-75th percentile range 6.3-6.3] in CG, [[Unable to Display Character: р]]<0.01). 9% of TG patients had pneumonia during 1 year vs 16% of patients in CG. In CG pneumonia provoked HF progression, in TG there was no statistically significant correlation between pneumonia and HF.
Conclusion: RMT in patients with severe HF are effective in decreasing the frequency of hospitalizations due to pneumonia and HF progression by improving physical capacity, ventilation parameters and inspiratory mouth pressure and decreasing the level of collagen synthesis and thus retarding fibrosis.
- © 2013 by American Heart Association, Inc.