Introduction. In the world practice, physical training is widely used in CHF patients. But in most cases, is not taken into account the influence of the initial clinical status of patients (gender, age, CHF NYHA, peak oxygen uptake, comorbidity) on the results of physical rehabilitation.
Purpose. To reveal the most significant predictors of inadequate response to physical rehabilitation in CHF patients, selected on the basis of achievement the lactate threshold during CPET.
Methods. 90 patients, CHF NYHA II-III were randomized into two groups - primary (aerobic training) and control (standard treatment of CHF). Main group - 77 patients, mean age 52±12,5 years, body mass index (BMI) 25,3±5,4 kg/m2, among them 55 patients (72%) had III CHF functional class and 22 patients (28%) – II CHF functional class. The control group - 13 patients, age 51±13,4 years, BMI was 25,4±5.2 kg/m2, 12 patients had III CHF functional class, 1 patient – II. The original estimated results of physical examination, laboratory parameters, comorbidity. CPET, quality of life (QOL), exercise tolerance (ET) was assessed at baseline and after 1,3,6 months of follow-up. The CPET served on tredmile using hardware. Echocardiography (EchoCG) were performed at baseline and after 6 months. The data were statistically processed using software package "Statistika, 9.0".
Results. In the main group after 6 months of training EF increased by 8.7±0.5% and End-diastolic volume decreased by 6±2.0 ml from baseline, QOL was changed by 17.5±8 points (significant regression of symptoms), ET increased by 9.5±1 points and VO2 peak increased by 4.4 ml/min/kg. In the control group showed an increase EF 4±1,1%, End-diastolic volume decreased by 68±14,8 ml, the change of QOL 14± 7,22 points, the increase in ET at 1.5 points, VO2 peak decreased by 1,7 ml/min/kg. Revealed a strong positive correlation between the initial values of VO2 peak and EF (rEF=0,4, p), and between baseline levels of sodium, hemoglobin and the of physical rehabilitation efficiency (rNa= 0,41, p,0,05; rHb = 0,45, p<0,05). There 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 a long history of CHF had a negative effect on the result of physical training (rBNP=-0,7, p=0.05; rCHF=-0,6, p=0.05). Significant differences in training performance between patients II and III functional class were not received.
Conclusion. Aerobic physical exercise in CHF patients, selected on the basis of lactate threshold achievement during the CPET, is effective in improving values of CPET, EchoCG, QOL and increasing exercise tolerance. Age, BNP and uric acid levels, CHF duration can be considered as most significant predictors of inadequate response to physical rehabilitation in CHF patients.