1Almazov National Medical Research Center - Saint-Petersburg - Russian Federation
Purpose. To study the efficiency and safety of aerobic physical rehabilitation (PR), based on original method, in heart failure patients with normal body mass; to evaluate morphometric changes in skeletal muscle fiber (MF) after PR.
Methods. 100 patients; heart failure with reduced ejection fraction (HFrEF) NYHA III, mean age 52 ± 5,2 years, body mass index (BMI) 23,5 ± 2,8 kg/m2, ejection fraction (EF) 27,3±4,2%. The original estimated cardiopulmonary exercising test (CPET), quality of life (QOL), exercise tolerance (ET) and echocardiography (EchoCG). PR efficiency was estimated on the basis of peak oxygen uptake (VO2peak), EF, QOL and ET dynamics after 6 months. Shin muscle biopsy was performed at baseline and after 3-6 months PR. In muscle samples activity of alkaline phosphatase (AP) and lactate dehydrogenase (LDH) was evaluated with plag-method. Data were statistically processed using software package "Statistika, 9.0".
Results. After 6 months PR EF increased by 10,5±2,3%, ET increased by 9,7±0,5 points (p1,2 <0,05), QOL changed by 24,8±3,5 points (significant regression of symptoms), VO2 peak increased by 5,2±0,5 ml/min/kg (?3,4 <0,05). Muscle fibers diameter (dMF) after PR slightly decreased in 6 patients, in 2 patients it did not change. After 3-6 mon. of physical training AP activity increased by 24,2% (p <0,05) and LDH activity in glycolytic MF decreased by 24,4%, in oxidative MF it decreased by 6,0% only (p1 <0,05, p2>0,05). There was a positive relationship between HF functional class dynamics and dMF (r = 0,4, p = 0,05), increase in CPET parameters was associated with AP activity (r = 0,5, p = 0,05).
Aerobic physical rehabilitation in stable HFrEF patients with normal body mass, selected on the basis of lactate threshold achievement, was effective in improving values of EF, QOL, VO2 peak and ET.After 3-6 mon.of PR diameter of muscle fibers slightly decreased;
Participating in the rehabilitation program decreased dMF and LDH activity in both oxidative and glycolytic muscle fibers; it also increased AP activity significantly. This may indicate a decrease in glycolytic metabolism activity and decrease in MF edema;
The relationship between the increase in exercise tolerance and endothelium condition marker (AP activity in muscle tissue) has been revealed.