Exercise Training and Left Ventricular Remodeling in HFpEF

Recent evidence suggests that smaller left ventricular (LV) dimensions are closely associated with impaired functional capacity in both healthy individuals and patients with symptomatic heart failure with preserved ejection fraction (HFpEF).1 Physiological exercise-induced remodeling changes are characterized by larger left ventricular end-diastolic volumes (LVEDVs) and greater diastolic distensibility, consistent with enhanced preload recruitment.2 Despite mixed and scarce evidence, some studies in individuals with cardiovascular risk factors suggest that exercise training leads to increases in indexed left ventricular end-diastolic volume (LVEDVi).3 However, the impact of different exercise training modalities on LV remodeling and whether such changes translate into functional improvement in symptomatic older patients with HFpEF remains largely uncertain. On this basis, we performed a post hoc analysis of the randomized TRAINING-HR (NCT05649787) trial4 to investigate whether a 12-week supervised exercise intervention modifies LVEDVi and whether these changes are associated with improvements in aerobic capacity in symptomatic patients with HFpEF and chronotropic incompetence (ChI).