Response predictors for physical training HFrEF patients

Abstract

Purpose. To identify different types and possible predictors of physical rehabilitation (PR) response in reduced ejection fraction heart failure (HFrEF) patients, selected on the basis of achievement the lactate threshold during cardiopulmonary exercising test (CPET). Methods. 64 patients, chronic heart failure (CHF) NYHA II-III functional class were included in our study. Mean age 54±12,5 years, body mass index (BMI) 26,5±6,4 kg/m², ejection fraction (EF) 26,4±1,4%, NYHA II: III (67%: 33% patients). ^e original estimated results of physical examination, laboratory parameters, CPET, quality of life (QOL), exercise tolerance (ET) and echocardiography (EchoCG). Physical rehabilitation (PR) efficiency was estimated on the basis of peak oxygen uptake (VO₂peak), QOL and ET dynamics after 1,3 and 6 months; EF dynamics was estimated after 6 months. Data were statistically processed using software package “Statistika, 9.0" Results. After 6 months PR EF increased by 7,5±0,5%, QOL - 17.5±8 points, ET - 9.5±1 points and VO₂ peak - 4.4 ml/min/kg, end-diastolic volume decreased by 6±2.0 ml from baseline (p₁,₂,₃,₄, respectively). Echocardiography, CPET, QOL and ET improvement revealed a significant number of patients (EF - 48%, VO₂ peak - 64%, QOL - 64%, ET - 67% of patients, respectively). Revealed a strong positive correlation between the initial values of VO₂ peak and EF (rEF=0,4, p), and between baseline levels of sodium, haemoglobin and the of PR efficiency (rNa= 0,41, p,0,05; rHb = 0,45, p<0,05). ^ere was a positive impact of the initial content of red blood cells (rEr=0,6, p=0.03), sodium (rNa=0,4, p=0.05), LV EF (r=0.5, p=0.05) and level VE at the peak of exercise load (r=0.5, p=0.01) on training efficiency. BNP level and HF long history had a negative effect on the result of PR (rBNP= - 0,7, p=0.05; rCHF= - 0,6, p=0.05). Revealed significant negative correlation between patient’s age and PR efficiency (r = -0,35, p<0,05). There was no significant impact of systolic blood pressure (rBP sist=0,11, p>00,5), diabetes mellitus on PR efficiency (r= -0,01, р<0,05). Conclusion. PR positive response predictors were VO₂ peak, hemoglobin and sodium higher initial values. Non-response predictors were CHF long history, older age, higher baseline NT-pro-BNP and uric acid blood.