Cardiac rehabilitation in heart failure patients yielded greater NT-proBNP reductions in those with moderate-severe versus mild-moderate functional limitation (-61.22 vs -49.25 pg/ml; P=0.024).
Cohort (n=100)
No
Does a 12-week cardiac rehabilitation program improve echocardiographic deformation parameters, functional status, and biomarkers in patients with heart failure?
A 12-week cardiac rehabilitation program significantly improves echocardiographic deformation parameters and biomarkers in heart failure patients, particularly those with more severe baseline functional limitations.
Absolute Event Rate: -61.22% vs -49.25%
p-value: p=0.024
Abstract Introduction Cardiac rehabilitation (CR), alongside optimal medical therapy, plays a key role in managing heart failure (HF), improving functional capacity and quality of life while reducing episodes of decompensation. Purpose We aimed to assess, after 6 months of CR participation, its impact on biological markers (NT-proBNP, hs-CRP, lipid profile), functional status, and echocardiographic parameters with prognostic relevance in HF—specifically left and right ventricular global longitudinal strain (LV/RV GLS) and left atrial reservoir strain. Methods We performed a prospective cohort study including 100 patients with HF (54% male; mean ejection fraction 43.15 ± 7.19%) who were admitted to a specialized cardiac rehabilitation center. Based on functional class (Weber classification) determined by cardiopulmonary exercise testing (CPET) at enrollment, patients were categorized into two groups: those with mild–moderate functional limitation (n=63) and those with moderate–severe limitation (n=37). Results Demographic, anthropometric, clinical, and paraclinical data were collected, with particular emphasis on functional and echocardiographic parameters as well as symptoms, NT-proBNP levels, lipid profile, an maximal oxygen consumption (VO2 max) at baseline and after 6 months. All participants completed a 12-week CR program (5 sessions per week) consisting of individualized aerobic and resistance training tailored according to CPET results. Patients with moderate-severe functional limitations showed additional improvement in functional parameters and quality of life compared to those in the first group: NT-proBNP levels: -49.25 pg/ml vs. -61.22 pg/ml, p=0.024), LDL-cholesterol: -21.7 vs. -30.01 mg/dl, p=0.057), C reactive protein (p=0.021). Echocardiographic parameters improved after 6 months of exercise (LV GLS: 0.79 vs, -0.92, p=0.039, -0.41 vs. -0. 58, p=0.031 for RV GLS, +0.58 vs. +1.01, p=0.014 for LAsr - associated with decreased filling pressures - mean E/E' ratio improved by 15%, p=0.024) correlated significantly with CPET parameters, with more significant results in the secondary group. In patients with moderate-severe functional limitation LV GLS values were statistically significantly correlated with NT-proBNP (p=0.019), peak oxygen uptake (p=0.037), NYHA class (p=0.021) and maximum walking distance (p=0.037). RV GLS also positively correlates with peak oxygen uptake (p=0.015). LV GLS less than -10.3% (AUC 0.750, p0.001, sensitivity 79%, specificity 67%) is a negative predictor for lack of functional improvement assessed by Weber functional class enhancement (Figure 1). Conclusions Cardiac rehabilitation programs enhance both systolic function and atrial performance in patients with heart failure. Improvements in LV and RV global longitudinal strain, as well as LAsr, may serve as echocardiographic indicators of better cardiorespiratory fitness six months after initiating CR.ROC CURVE - LV GLSFor image description, please refer to the figure legend and surrounding text.
Adam et al. (Mon,) conducted a cohort in Heart failure (n=100). Moderate-severe functional limitation (undergoing cardiac rehabilitation) vs. Mild-moderate functional limitation was evaluated on Change in NT-proBNP levels (pg/ml) (p=0.024). Cardiac rehabilitation in heart failure patients yielded greater NT-proBNP reductions in those with moderate-severe versus mild-moderate functional limitation (-61.22 vs -49.25 pg/ml; P=0.024).