Cardiac rehabilitation in non-ischaemic cardiomyopathies: functional, psychosocial, and structural benefits compared with coronary artery disease

Abstract Background Cardiac rehabilitation (CR) improves exercise capacity, ventilatory efficiency, and quality of life (QoL) in patients with coronary artery disease (CAD) and heart failure, but evidence in non-ischaemic cardiomyopathies (NICM) remains limited. Methods We retrospectively analysed 606 consecutive patients who completed a centre-based CR programme at our University Hospital (2011-2025), including CAD (n=398), dilated cardiomyopathy (DCM; n=59), non-dilated left ventricular cardiomyopathy (NDLVC; n=49), and hypertrophic cardiomyopathy (HCM; n=19). The primary endpoint was change in peak oxygen uptake (VO2peak). Secondary endpoints (2017-2025, n≈260) comprised six-minute walk distance (6MWT), ventilatory efficiency (VE/VCO2 slope), psychological status (PHQ-8, GAD-7), biomarkers (NT-proBNP, LDL cholesterol, HbA1c), and echocardiographic indices. Multivariable regression explored predictors of outcome. Results VO2peak improved by +2.7 ± 4.4 mL·kg−¹·min−¹ (p0.001), with gains in CAD, DCM, and HCM, but attenuated response in NDLVC (+0.8 vs +3.0 mL·kg−¹·min−¹; p=0.003). 6MWT increased by +51 m overall, greatest in CAD, DCM, and NDLVC. Psychological measures improved (PHQ-8 -0.8, GAD-7 -0.6; both p0.01). NT-proBNP fell by -225 pg/mL (p0.001; DCM ≈-390 pg/mL). In CAD, LDL cholesterol decreased from 1.75 ± 0.90 to 1.50 ± 0.61 mmol/L (p0.001), while LDL in other groups and HbA1c across all groups remained unchanged. Echocardiography showed improved LVEF (+4.7%) and reduced LVEDVi (-5.4 mL/m²), especially in DCM. Patients with lower baseline LVEF had greater VE/VCO2 slope reduction, indicating disproportionate improvements in ventilatory efficiency. Conclusions CR was associated with multidimensional benefits across functional, biomarker, structural, and psychosocial domains in both ischaemic and non-ischaemic cardiomyopathies. NDLVC patients displayed attenuated VO2peak gains compared with CAD but clinically meaningful improvements in 6MWT, underscoring the value of CR even when maximal aerobic capacity is less responsive. Moreover, patients with lower baseline LVEF showed disproportionate improvements in ventilatory efficiency, supporting the inclusion of this subgroup in CR. These findings argue for the routine integration of NICM patients into CR, while prospective studies are warranted to confirm and refine subgroup-specific effects.For image description, please refer to the figure legend and surrounding text.