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Int J Angiol 2019; 28(01): 044-049
DOI: 10.1055/s-0038-1676836
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction

Anwar Santoso
1   Department of Cardiology – Vascular Medicine, Faculty of Medicine – Universitas Indonesia, National Cardiovascular Centre – Harapan Kita Hospital, Jakarta, Indonesia
,
Sidhi Laksono Purwowiyoto
2   Department of Cardiology –Vascular Medicine, Pasar Rebo Hospital, Jakarta Timur, Indonesia
,
Budhi Setianto Purwowiyoto
1   Department of Cardiology – Vascular Medicine, Faculty of Medicine – Universitas Indonesia, National Cardiovascular Centre – Harapan Kita Hospital, Jakarta, Indonesia
,
Amiliana Mardiana Soesanto
1   Department of Cardiology – Vascular Medicine, Faculty of Medicine – Universitas Indonesia, National Cardiovascular Centre – Harapan Kita Hospital, Jakarta, Indonesia
› Author Affiliations
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Publication History

Publication Date:
08 January 2019 (online)

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Abstract

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).

The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.

This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.

Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).

Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.

Keywords

heart failure with preserved ejection fraction - 6-minute walk test - four-chamber longitudinal strain - Minnesota living with heart failure
 

  • References

  • 1 Hamdani N, Paulus WJ. Treatment of heart failure with normal ejection fraction. Curr Treat Options Cardiovasc Med 2011; 13 (01) 26-34
    CrossrefPubMedSearch in Google Scholar
  • 2 Owan TE, Hodge DO, Herges RM. , et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355 (03) 251-259
    CrossrefPubMedSearch in Google Scholar
  • 3 Paulus WJ, van Ballegoij JJ. Treatment of heart failure with normal ejection fraction: an inconvenient truth!. J Am Coll Cardiol 2010; 55 (06) 526-537
    CrossrefPubMedSearch in Google Scholar
  • 4 Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 2002; 105 (11) 1387-1393
    CrossrefPubMedSearch in Google Scholar
  • 5 Dickstein K, Cohen-Solal A, Filippatos G. , et al; ESC Committee for Practice Guidelines (CPG). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10 (10) 933-989
    CrossrefPubMedSearch in Google Scholar
  • 6 Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 2011; 32 (06) 670-679
    CrossrefPubMedSearch in Google Scholar
  • 7 European Study Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur Heart J 1998; 19 (07) 990-1003
    CrossrefPubMedSearch in Google Scholar
  • 8 Vasan RS, Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation 2000; 101 (17) 2118-2121
    CrossrefPubMedSearch in Google Scholar
  • 9 Gorcsan III J, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol 2011; 58 (14) 1401-1413
    CrossrefPubMedSearch in Google Scholar
  • 10 Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart 2010; 96 (24) 2032-2040
    CrossrefPubMedSearch in Google Scholar
  • 11 McMurray JJV, Adamopoulos S, Anker SD. , et al; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33 (14) 1787-1847
    CrossrefPubMedSearch in Google Scholar
  • 12 ACSM. Guidelines for Exercise Testing and Prescription. 8. Philadelphia: Lippincott William & Wilkins; 2010
    Search in Google Scholar
  • 13 American Thoracic Society. ATS statement: guidelines for the six-minute walk test. This Official Statement of the American Thoracic Society was approved by the ATS Board of Directors March 2002. Am J Respir Crit Care Med 2002; 166: 111-117
    CrossrefPubMedSearch in Google Scholar
  • 14 Bilbao A, Escobar A, García-Perez L, Navarro G, Quirós R. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes 2016; 14: 23
    CrossrefPubMedSearch in Google Scholar
  • 15 Cacciapuoti F, Scognamiglio A, Paoli VD, Romano C, Cacciapuoti F. Left atrial volume index as indicator of left ventricular diastolic dysfunction: comparation between left atrial volume index and tissue myocardial performance index. J Cardiovasc Ultrasound 2012; 20 (01) 25-29
    CrossrefPubMedSearch in Google Scholar
  • 16 Munagala VK, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Association of newer diastolic function parameters with age in healthy subjects: a population-based study. J Am Soc Echocardiogr 2003; 16 (10) 1049-1056
    CrossrefPubMedSearch in Google Scholar
  • 17 Pearson MJ, Mungovan SF, Smart NA. Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2017; 22 (02) 229-242
    CrossrefPubMedSearch in Google Scholar
  • 18 Edelmann F, Gelbrich G, Düngen HD. , et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 2011; 58 (17) 1780-1791
    CrossrefPubMedSearch in Google Scholar
  • 19 Tamura H, Watanabe T, Nishiyama S. , et al. Increased left atrial volume index predicts a poor prognosis in patients with heart failure. J Card Fail 2011; 17 (03) 210-216
    CrossrefPubMedSearch in Google Scholar
  • 20 Russo C, Sera F, Jin Z. , et al. Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: a population-based cohort study. Eur J Heart Fail 2016; 18 (05) 537-544
    CrossrefPubMedSearch in Google Scholar
  • 21 Edwards NC, Moody WE, Yuan M. , et al. Quantification of left ventricular interstitial fibrosis in asymptomatic chronic primary degenerative mitral regurgitation. Circ Cardiovasc Imaging 2014; 7 (06) 946-953
    CrossrefPubMedSearch in Google Scholar
  • 22 Kamperidis V, Marsan NA, Delgado V, Bax JJ. Left ventricular systolic function assessment in secondary mitral regurgitation: left ventricular ejection fraction vs. speckle tracking global longitudinal strain. Eur Heart J 2016; 37 (10) 811-816
    CrossrefPubMedSearch in Google Scholar
  • 23 Kasner M, Gaub R, Sinning D. , et al. Global strain rate imaging for the estimation of diastolic function in HFNEF compared with pressure-volume loop analysis. Eur J Echocardiogr 2010; 11 (09) 743-751
    CrossrefPubMedSearch in Google Scholar
  • 24 Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100 (21) 1673-1680
    CrossrefPubMedSearch in Google Scholar
  • 25 Russo C, Jin Z, Elkind MS. , et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail 2014; 16 (12) 1301-1309
    CrossrefPubMedSearch in Google Scholar
  • 26 Tops LF, Delgado V, Marsan NA, Bax JJ. Myocardial strain to detect subtle left ventricular systolic dysfunction. Eur J Heart Fail 2017; 19 (03) 307-313
    CrossrefPubMedSearch in Google Scholar
  • 27 Bowen TS, Rolim NPL, Fischer T. , et al; Optimex Study Group. Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle. Eur J Heart Fail 2015; 17 (03) 263-272
    CrossrefPubMedSearch in Google Scholar
  • 28 Nunes RB, Alves JP, Kessler LP, Dal Lago P. Aerobic exercise improves the inflammatory profile correlated with cardiac remodeling and function in chronic heart failure rats. Clinics (São Paulo) 2013; 68 (06) 876-882
    CrossrefPubMedSearch in Google Scholar
  • 29 Wu SF. Rapid screening of psychological well-being of patients with chronic illness: reliability and validity test on WHO-5 and PHQ-9 scales. Depress Res Treat 2014; 2014: 239490
    PubMedSearch in Google Scholar
  • 30 Evangelista LS, Cacciata M, Stromberg A, Dracup K. Dose-response relationship between exercise intensity, mood states, and quality of life in patients with heart failure. J Cardiovasc Nurs 2017; 32 (06) 530-537
    CrossrefPubMedSearch in Google Scholar
  • 31 Nolte K, Herrmann-Lingen C, Wachter R. , et al. Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the Ex-DHF-P trial. Eur J Prev Cardiol 2015; 22 (05) 582-593
    CrossrefPubMedSearch in Google Scholar
  • 32 Isaksen K, Munk PS, Giske R, Larsen AI. Effects of aerobic interval training on measures of anxiety, depression and quality of life in patients with ischaemic heart failure and an implantable cardioverter defibrillator: a prospective non-randomized trial. J Rehabil Med 2016; 48 (03) 300-306
    CrossrefPubMedSearch in Google Scholar
  • 33 Smart NA, Haluska B, Jeffriess L, Leung D. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail 2012; 18 (06) 295-301
    CrossrefPubMedSearch in Google Scholar