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Cardiac rehabilitation programs in left ventricular systolic dysfunction patients: differences between risk profile and functional capacity according to ejection fraction.

Session Poster session 3

Speaker Oscar Gonzalez Fernandez

Event : Heart Failure 2017

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : O Gonzalez Fernandez (Madrid,ES), FJ Irazusta Cordoba (Madrid,ES), V Rial Baston (Madrid,ES), P Meras Colunga (Madrid,ES), R Dalmau Gonzalez-Gallarza (Madrid,ES), C Alvarez Ortega (Madrid,ES), R Mori Junco (Madrid,ES), S Rosillo Rodriguez (Madrid,ES), A Castro Conde (Madrid,ES), JL Lopez-Sendon (Madrid,ES)

Authors:
O Gonzalez Fernandez1 , FJ Irazusta Cordoba1 , V Rial Baston1 , P Meras Colunga1 , R Dalmau Gonzalez-Gallarza1 , C Alvarez Ortega1 , R Mori Junco1 , S Rosillo Rodriguez1 , A Castro Conde1 , JL Lopez-Sendon1 , 1University Hospital La Paz, Cardiology - Madrid - Spain ,

Citation:
European Journal of Heart Failure ( 2017 ) 19 ( Suppl. S1 ), 490

Introduction: Cardiac rehabilitation programs (CRPs) in left ventricular systolic dysfunction (LVSD) patients provide optimal medical treatment, as well as supervised exercise, education and counselling. Our purpose was to compare the risk profile and functional capacity according to the ejection fraction (EF) in LVSD patients performing a CRP. Methods: We made an observational retrospective study including patients with reduced EF (LVEF <40%) and mid-range EF (LVEF 40-49%) admitted to a CRP in our institution between 2006 and 2015. Physical training, optimal pharmacological treatment, medical counselling, nutritional education, and smoking cessation support when needed, were supplied for 8 to 10 weeks. Left ventricular ejection fraction (LVEF) was assessed before and after the program using transthoracic echocardiography, selecting in our study patients with a LVEF <50%. FC was tested before and after the CRP according to the NYHA Functional Classification, in addition to a treadmill stress test (TST). Exercise capacity (EC) was reported in terms of estimated metabolic equivalents of task (METs). Results: A total of 442 patients were included, mean age 57.93±11.78 years, male 89.6%. Cardiac rehabilitation was performed after a recent acute coronary syndrome in 91.2% of patients. No statistically significant differences depending on the previous cardiovascular risk profile and comorbidities between mid-range EF (mrEF) and reduced EF (rEF) patients were found (table 1). Medical therapy when starting the program showed a significantly higher use of ACEIs/ARBs, MRAs, diuretics and anticoagulants in rEF than mrEF patients (p=0.023, p<0.001, p<0.001 and p=0.003; respectively). Patients with rEF had a worse FC assessed by NYHA class than mrEF patients, class I (43.4% vs 72.4%), II (49.8% vs 25.4%), III (6.3% vs 2.2%), IV (0.5% vs 0%); p<0.001. EC reported in METs was significantly lower in rEF than mrEF patients before (6.22±2.73 vs 7.76±2.38; p<0.001) and after the program (9.82±2.68 vs 10.65±2.42; p=0.003). After completing the CRP an increase in LVEF was observed in both groups (mrEF patients increased LVEF from 43.81±3.09% to 52.53±6.60%, rEF patients from 30.59±5.83% to 42.62±10.75%). FC after the program was significantly higher in the mrEF than the rEF group (I: 92.1% vs 73.4%, II: 7.9% vs 25.5%, III: 0% vs 1.1%; p<0.001). Regarding the heart rhythm, there was a non-significant trend showing an increased prevalence of atrial fibrillation in rEF patients (7.2% vs 3.1%; p=0.06). The dropout rate of the CRP was similar in both groups (11.9% in rEF patients vs 7.8%). Conclusions: Reduced ejection fraction patients included in a CRP have a lower functional and exercise capacity than mid-range ejection fraction patients, both before and after completing the program. LVSD patients have a high prevalence of cardiovascular risk factors and comorbidities. However, no differences are found according to the left ventricular ejection fraction.

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