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Effects of cardiovascular rehabilitation in heart failure patients with mid-range ejection fraction: is there age difference?

Session Poster Session 1

Speaker Dragan Marinkovic

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Rehabilitation
  • Session type : Poster Session

Authors : D Marinkovic (Nis,RS), M Deljanin Ilic (Nis,RS), V Stoickov (Nis,RS), B Ilic (Nis,RS), I Krstic (Nis,RS), D Petrovic (Nis,RS)

D Marinkovic1 , M Deljanin Ilic2 , V Stoickov2 , B Ilic1 , I Krstic1 , D Petrovic1 , 1Institute for Treatment and Rehabilitation Niska Banja - Nis - Serbia , 2University of Nis, Medical Faculty, Institute of Cardiology Niska Banja - Nis - Serbia ,


Background: The positive effects of exercise training in patients with chronic heart failure (CHF) are reflected in improving exercise tolerance, reduce symptoms and less hospitalization, increasing survival and improving quality of life (QOL). Elderly patients have more advanced CHF than younger because they tend to be more sedentary and thus do not note symptoms or do not receive a diagnosis of CHF until their cardiac limitation is advanced. Heart failure with mid-range ejection fraction (HFmrEF), the "middle child", as a new entity, in heart failure family, has limited data regarding exercise tolerance and training, functional capacity and QOL.
Objective: To evaluate the effects of short-term exercise training on physical exercise, tolerance and level of markers of inflammation, neuro-humoral activation, endothelial function and QOL in patients with HFmrEF, in relation to age.
 Patients and Methods: The study involved 36 HF patients (21 male; mean age 60.5 ± 4.7 years, with established ischemic heart disease, which fulfill criteria for HFmrEF. All patients were included in three-week rehabilitation program in the residential center, based on strictly controlled and individually prescribed exercise 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. In relation to age, patients were divided into three groups: A (n=14, <60 yrs), B (n=10, 60-69 yrs) and C (n=8, =70 yrs). 
Results: After rehabilitation, in group C, significantly lower serum ANP (p = 0.048), BNP (p=0,034) and ET (p=0,047) were registered, compared to the values before rehabilitation. In groups A and B, there was decreasing trend of these neurohormons after rehabilitation but without significance. After rehabilitation, value of BNP was lower in group C than in group B (p=0,067), and significantly lower than in group A (p=0,04), while ANP and ET did not show significant changes in all three groups. Inflammatory markers: erythrocyte sedimentation rate (ESR), hs-CRP, fibrinogen, and white blood cell count (WBC) after cardiovascular rehabilitation showed a decreasing trend but not significant, in all groups. Exercise tolerance improved in all groups (p <0.001 for all). After the rehabilitation in group C, heart rate at rest, was substantially lower than in the group A (p = 0.03) and B (p=0,038). The quality of life assessed by Minnesota Living With Heart Failure Questionnaire was improved in all groups (p=0,001).
Conclusion: Residential short-term rehabilitation decreased the level of neurohormons (ANP,BNP,ET) in patients with  mid-range CHF, especially in patients older than 70 year. Those positive effects on neurohumoral status were associated with significant increase of exercise tolerance, improvement of QOL and decreasing trend of inflammatory markers.

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