Why the study?
Response to supervised exercise training in HFrEF varies between patients, and the factors responsible for a positive response remain unclear.
What are the cardiac hemodynamic changes and best discriminators of response to a 4-week exercise training program in HFrEF patients?
What are the cardiac hemodynamic changes and best discriminators of response to a 4-week exercise training program in HFrEF patients?
VO2peak and peak cardiac output are strong discriminators of positive response to a 4-week exercise training program in HFrEF patients.
VO2peak may identify HFrEF patients likely to respond to short-term exercise training; hypothesis-generating and requires prospective validation before clinical adoption.
Background: Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training. Methods: Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (VO 2peak ). Results: There were statistically significant differences in VO 2peak (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (CO peak ) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. VO 2peak was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by CO peak (ROC AUC = 0.77, P < 0.0001). Conclusion: VO 2peak is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status. Cardiol Res. 2024;15(1):18-28 doi: https://doi.org/10.14740/cr1591
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Kirsch et al. (2024) studied this question.
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