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

Abstract

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.

• Authors: Kayo Misumi, Michio Nakanishi, Hiroyuki Miura, Ayumi Date, Tatsuo Tokeshi, Leon Kumasaka, Tetsuo Arakawa, Kazuhiro Nakao, Takuya Hasegawa, Shigefumi Fukui, Masanobu Yanase, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Yoichi Goto
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 86 Issue 1 Pg. 49-57 (12 24 2021) ISSN: 1347-4820 [Electronic] Japan
• PMID: 34193751 (Publication Type: Journal Article)

Topics

• Atrial Fibrillation (therapy)
• Cardiac Rehabilitation
• Cardiac Resynchronization Therapy
• Exercise Tolerance
• Heart Failure (therapy)
• Humans
• Stroke Volume (physiology)
• Treatment Outcome
• Ventricular Function, Left