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. 2012 Dec;164(6):869-77.
doi: 10.1016/j.ahj.2012.06.028. Epub 2012 Oct 29.

Cardiovascular effects of 1 year of progressive endurance exercise training in patients with heart failure with preserved ejection fraction

Naoki Fujimoto  1 , Anand Prasad, Jeffrey L Hastings, Paul S Bhella, Shigeki Shibata, Dean Palmer, Benjamin D Levine
Affiliations

Cardiovascular effects of 1 year of progressive endurance exercise training in patients with heart failure with preserved ejection fraction

Naoki Fujimoto et al. Am Heart J. 2012 Dec.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a disease of the elderly with cardiovascular stiffening and reduced exercise capacity. Exercise training appears to improve exercise capacity and cardiovascular function in heart failure with reduced ejection fraction. However, it is unclear whether exercise training could improve cardiovascular stiffness, exercise capacity, and ventricular-arterial coupling in HFpEF.

Methods: Eleven HFpEF patients and 13 healthy controls underwent invasive measurements with right heart catheterization to define Starling and left ventricular (LV) pressure-volume curves; secondary functional outcomes included Doppler echocardiography, arterial stiffness, cardiopulmonary exercise testing with cardiac output measurement, and ventricular-arterial coupling assessed by the dynamic Starling mechanism. Seven of 11 HFpEF patients (74.9 ± 6 years; 3 men/4 women) completed 1 year of endurance training followed by repeat measurements. Pulmonary capillary wedge pressures and LV end-diastolic volumes were measured at baseline during decreased and increased cardiac filling. LV compliance was assessed by the slope of the pressure-volume curve. Beat-to-beat LV end-diastolic pressure (estimated from pulmonary arterial diastolic pressure) and stroke volume index were obtained, and spectral transfer function analysis was used to assess the dynamic Starling mechanism.

Results: Before training, HFpEF patients had reduced exercise capacity, distensibility and dynamic Starling mechanism but similar LV compliance and end-diastolic volumes compared to controls albeit with elevated filling pressure and increased wall stress. One year of training had little effect on LV compliance and volumes, arterial stiffness, exercise capacity or ventricular-arterial coupling.

Conclusion: Contrary to our hypothesis, 1 year of endurance training failed to impart favorable effects on cardiovascular stiffness or function in HFpEF.

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Figures

Figure 1
Figure 1
Frank Starling relationship. Lines represent results of second linear regression analyses for HFpEF patients before (r = 0.99) and after (r = 0.99) training and controls (r = 0.99). Note no differences in stroke volume index for any given PCWP in HFpEF patients before and after training.
Figure 2
Figure 2
Preload recruitable stroke work. Lines represent results of linear regression analyses for HFpEF patients before (r = 0.97) and after (r = 0.94) training and controls (r = 0.98). Stroke work was unaffected across all loading conditions in HFpEF patients after training (P = .239).
Figure 3
Figure 3
A, B. Diastolic pressure-volume relationships. A, Pressure-volume curves for HFpEF patients before (r = 0.98) and after (r = 0.99) training and controls (r = 0.97). No significant changes in pressure-volume curves were observed after training. B, Transmural pressures-volume curves for HFpEF patients before (r = 0.94) and after (r = 0.96) training and controls (r = 0.91). No significant changes were observed in pressure-volume curves after training.
Figure 4
Figure 4
Peak oxygen uptake. A year of training had no effects on absolute or indexed VO2peak in HFpEF patients.
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