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Cardiac rehabilitation in patients with heart failure reduced ejection fraction compared to patients with coronary artery disease preserved ejection fraction: a long term follow up
Authors : J Cornelis (Antwerp,BE), C Vrints (Antwerp,BE), E Roelant (Antwerp,BE), T Van Soom (Antwerp,BE), N Possemiers (Antwerp,BE), K Wuyts (Antwerp,BE), E Van Craenenbroeck (Antwerp,BE), P Beckers (Antwerp,BE)
T Van Soom1
E Van Craenenbroeck2
1University of Antwerp, Department of Physiotherapy (REVAKI) - Antwerp - Belgium
2University of Antwerp Hospital (Edegem), Department of Cardiology - Antwerp - Belgium
3University of Antwerp Hospital (Edegem), Department of Scientific Coordination and Biostatistics - Antwerp - Belgium
European Journal of Heart Failure
Background: Patients with exercise intolerance induced by heart failure reduced ejection fraction (HFrEF) benefit from cardiac rehabilitation as exercise reverses the established prognostic cardiopulmonary parameters assessed through a cardiopulmonary exercise test (CPET). The clinical relevance and prognostic significance of these markers, together with the effect of exercise training in patients with coronary artery disease and preserved ejection fraction (CAD), is dubious.
Methods: The database was searched and 181 patients (CHF: n=35; CAD: n=146) were included between 2004 and 2010. All patients followed an endurance training program in the cardiac rehabilitation centre (38s, 3m, 3x60'/wk, 90%HR@RCP). During the first 24 sessions, the patients trained 5x8´on different training devices. After, exercise time was increased towards 4x10´. At the beginning and the end of the program, a maximal CPET (RER>1.15)(20 or 40 W/min) was conducted. Mortality rate was registered during a 5-year follow-up and survival analyses were performed. Significance was set P< 0.05.
Results: Baseline characteristics of both populations are given for patients with HFrEF (age: 54.8±11.7; EF: 24.2±7.8) and CAD (age: 59.0±10.1; EF: 58.0±9.5). Both groups significantly improved peak VO2, VE/VCO2 slope, HRR-1, Peak PetCO2, half-time of peak VO2, and OUES after 3 months of cardiac rehabilitation. The EqCO2 improved significant in the group with CAD. The patients with CAD improved peak VO2 significantly more (P=0.032) compared to the patients with HFrEF. Secondary parameters improved all significantly in both groups, only for peak(W/VO2) the patients with HFrEF improved significantly (P< 0.001) more. Moreover, the circulatory power improved significantly (P< 0.001) more in CAD. Exercise oscillatory ventilation (n=4) was present at baseline. The 5-year mortality rate was 17.1% in patients with HFrEF and 5.5% in patients with CAD. The cox-regression analysis illustrated a significant difference (P=0.03) in the 5-year survival comparing both groups. The hazard ratio was 4.9 (P=0.05). Patients who increased their Peak VO2 by 20% (responders) with cardiac rehabilitation were not significant different of the non-responders (P=0.30) and hazard ratio was 0.417 (P=0.31).
Conclusion: A significant positive effect of cardiac rehabilitation in both populations was found. In patients with CAD, exercise training appeared to have more effect on aerobic capacity, circulatory power and EOV, whereas in patients with HFrEF work efficiency enhanced. Despite these improvements, the probability of dying within 5 years was high, however decreased by 58.3% if the patient responded on training. Improvements of prognostic CPET parameters seem to indicate that cardiac rehabilitation benefits all patients with a cardiac disease and perhaps even more the patients with CAD.
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