Reverse remodelling through exercise training is more pronounced in non-ischemic heart failure

• Published in: Clinical research in cardiology Vol. 97; no. 12; pp. 865 - 871
• Main Authors: Delagardelle, Charles MD, Feiereisen, Patrick MSc, Vaillant, Michel PhD, Gilson, Georges PhD, Lasar, Yves MD, Beissel, Jean MD, Wagner, Daniel R. MD, PhD
• Format: Journal Article
• Language: English
• Published: Dordrecht Dordrecht : D. Steinkopff-Verlag 01-12-2008; D. Steinkopff-Verlag; Springer Nature B.V
• Subjects: Aged; Cardiology; Clinical trials; Drug therapy; Echocardiography - methods; Exercise Therapy - methods; Female; Heart failure; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Ischemia - physiopathology; Myocardial Ischemia - therapy; Original Paper; Oxygen Consumption; Radionuclide Ventriculography - methods; Ventricular Dysfunction, Left - therapy; Ventricular Remodeling; CHF; ischemic and non-ischemic aetiology; training; LV remodeling
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-008-0698-x

Purpose Most training studies in patients with chronic heart failure (CHF) do not consider CHF aetiology in the interpretation of the results. About 60% of the patients in those studies have ischemic CHF (IHF) and 40% non-ischemic CHF (NHF). Recently, we conducted a randomized controlled trial to study three different training modalities in 60 patients with severe CHF, with a similar distribution of IHF and NHF patients. In the present post hoc analysis we compared the differences in training results between ischemic and non-ischemic patients. Methods Left ventricular ejection fraction (EF), end diastolic volume (EDV), end systolic volume (ESV), measured with radionuclide ventriculography (RNV) and echocardiography, NT-pro BNP, peak oxygen uptake (peak [graphic removed] ), working capacity and muscular volume were analyzed before and after training in 45 patients training for 40 sessions, 3 times per week. Fifteen patients served as control group. The outcome was analyzed considering the aetiology of CHF, either ischemic or non-ischemic. Results There were no significant differences in improvements of peak [graphic removed] , working capacity and muscular volume between IHF and NHF patients. In NHF patients, EF increased while EDV and ESV decreased after training. These parameters remained unchanged in IHF patients after training. NT-pro BNP decreased significantly in NHF patients and increased in IHF patients after training. In the control group, patients showed a mild improvement of EF and a decrease of NT-pro BNP. Conclusion This post hoc analysis shows that training intervention is associated with significant reverse remodelling in NHF, but not in IHF patients, whereas [graphic removed] peak and muscle volume improve regardless of CHF aetiology. Future prospective studies are needed to confirm our findings.