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Heart failure with mid-range ejection fraction:the effects of short-term physical training
1University of Nis, Medical Faculty, Institute of Cardiology Niska Banja - Nis - Serbia
Heart failure with mid-range ejection fraction (HFmrEF), the „midlle child", as a new entity, in heart failure familly, has limited data regarding exercise tolerance and training, functional capacity and quality of life (QOL). Available data suggest that it constitutes a sizeable proportion(10–20%) of the HF population, has a unique clinical, echocardiographic, haemodynamic, and biomarker profile compared with HFrEF and HFpEF, and carries a poor prognosis.
Aim: To evaluate the effects of short-term physical training on physical exercise, tolerance and level of markers of inflammation, neuro-humoral activation and endothelial function, in patients wit HFmrEF.
Methods: The study involved 33 HF patients (21 males); mean age 60.3 ± 5.7 years, with established ischemic heart disease, mean EF 44,58 ± 5,23%, which fulfill criteria for HFmrEF. All patients were included in three-weeks rehabilitation program in the residential center, based on strictly controlled and individually prescribed physical training. Before and after rehabilitation, all patients were underwent exercise stress test, and from the veins blood samples, biochemical markers of inflammation, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) an endothelin (ET) were determined.
Results: At the end of the study the hs-CRP and fibrinogen level were showed a decreasing trend (p=0.42; p=0.68 n.s). After cardiovascular rehabilitation a significant reduction in white blood cells count was recorded (p=0.022). Erythrocyte sedimentation rate after rehabilitation was higher, but not significant. In all pts, the concentration of ANP and BNP was lower after 3 weeks compared to baseline values (p=0.023; p=0.019). In contrast, the value of endothelin after rehabilitation was higher than baseline value (p=0.112), but not significant. At end of this study, significantly higher serum HDL-cholesterol in CHF patients was found (p=0.001). Exercise tolerance after rehabilitation was improved (55.35 ± 5,23 W vs 74.69± 6.13 W; p=0.047), as well as quality of life assessed by Minnesota Living With Heart Failure Questionnaire (58,69± 3,69 vs 38,39± 2,24 p=0.035)
Conclusion: The results of our study showed that, in patients with the midrange LVEF residential short-term training has favourable impact expressed throught decreasing of the level of inflammatory status and neuropeptids. Those positive effects are associated with significant increases of exercise tolerance and improvement of quality of life.
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