Exercise-Based Cardiac Rehabilitation Improves Exercise Capacity Regardless of the Response to Cardiac Resynchronization Therapy in Patients With Heart Failure and Reduced Ejection Fraction

• Published in: Circulation Journal Vol. 86; no. 1; pp. 49 - 57
• Main Authors: Misumi, Kayo, Nakanishi, Michio, Miura, Hiroyuki, Date, Ayumi, Tokeshi, Tatsuo, Kumasaka, Leon, Arakawa, Tetsuo, Nakao, Kazuhiro, Hasegawa, Takuya, Fukui, Shigefumi, Yanase, Masanobu, Noguchi, Teruo, Kusano, Kengo, Yasuda, Satoshi, Goto, Yoichi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24-12-2021
• Subjects: Atrial Fibrillation - therapy; Cardiac Rehabilitation; Cardiac Resynchronization Therapy; Exercise capacity; Exercise Tolerance; Good responder; Heart failure; Heart Failure - therapy; Humans; Stroke Volume - physiology; Treatment Outcome; Ventricular Function, Left; Heart failure; Cardiac resynchronization therapy; Exercise capacity; Cardiac rehabilitation; Good responder
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-1300

Background:In patients with chronic heart failure with reduced ejection fraction (HFrEF), cardiac resynchronization therapy (CRT) improves left ventricular ejection fraction (LVEF) and exercise-based cardiac rehabilitation (ECR) enhances exercise capacity. This study examined the relationship between the 2 responses.Methods and Results:Sixty-four consecutive HFrEF patients who participated in a 3-month ECR program after CRT were investigated. Patients were categorized according to a median improvement in peak oxygen uptake (PV̇O2) after ECR of 7% as either good (n=32; mean percentage change in PV̇O2[%∆PV̇O2]=23.2%) or poor (n=32; mean %∆PV̇O2=2.5%) responders. There was no significant difference in baseline characteristics between the good and poor responders, except for PV̇O2(51% vs. 59%, respectively; P=0.01). The proportion of good CRT responders was similar between the good and poor responders (%∆LVEF ≥10%; 53% vs. 47%, respectively; P=NS). Overall, there was no significant correlation between %∆LVEF after CRT and %∆PV̇O2after ECR. Notably, among poor CRT responders (n=32), the prevalence of atrial fibrillation (0% vs. 29%; P<0.03) and baseline PV̇O2(48% vs. 57%; P<0.05) were significantly lower among those with a good (n=15) than poor (n=17) response to ECR.Conclusions:In patients with HFrEF, good ECR and CRT responses are unrelated. A good PV̇O2response to ECR can be achieved even in poor CRT responders, particularly in those with a sinus rhythm or low baseline PV̇O2.