Training-Induced Change of Diastolic Function in Heart Failure with Preserved Ejection Fraction

Figure 1. Study flowchart. Patients were assessed at baseline and 3 months. Of 180 patients randomized, 61 were included in this substudy, after excluding patients who were ineligible after core lab review of inclusion criteria, patients included at centres without exercise echo facilities and patients who did not perform exercise echo for other reasons. A total of 51 patients underwent exercise echocardiography at 3 months follow‐up. All patients who had exercise echocardiography at baseline were included for statistical analysis.

Figure 2. Selected exercise echocardiography measurements at baseline and 3 months. Red circles represent patients in control group, blue triangles patients in training group. Left side of graph represent measurements at baseline, right side at 3 months. Percentage change from rest to peak is mentioned. (A) E/e′ ratio, (B) LVEF, (C) PAPs and (D) TAPSE, *P < 0.05 for significant change from rest to max exercise at a given timepoint; †P‐time < 0.05 indicating significant overall change from baseline to 3 months; $P‐interaction < 0.05 indicating significantly different evolution over time between control and training group. LVEF, left ventricular ejection fraction; PAPs, pulmonary artery pressure systolic; TAPSE, tricuspid annular plane systolic excursion.

Figure 3. Correlation between changes in aerobic capacity and diastolic function. Changes in E/e′ were correlated to changes in V̇O2peak in patients randomized to training, to assess the contribution of improved diastolic function to training response. (A) Change in maximal E/e′ between baseline and 3 months, relative to change in V̇O2peak between baseline and 3 months. (B) Change in ∆E/e′ (i.e., E/e′ max − E/e′ rest) between baseline and 3 months, relative to change in V̇O2peak between baseline and 3 months. Rho values indicate Spearman's correlation coefficient, with values <0.5 indicating poor correlation. Max E/e′, highest E/e′ recorded during stress echocardiography; ∆E/e′, increase in E/e′ from rest to exercise; V̇O2peak, peak aerobic capacity.