Effectiveness of cardiovascular rehabilitation programs among patients with heart failure based on myocardial deformation and atrial function echocardiographic predictors

Cardiac rehabilitation (CR) plays an important role in heart failure (HF) contributing to stopping functional decline, relieving symptoms and increasing quality of life in combination with optimal therapeutic management.

We aimed to evaluate the impact of participating in a CR program after 6 months in terms of biological (N-terminal pro b-type natriuretic peptide [NT-proBNP], inflammatory biomarkers) and echocardiographic parameters (left and right ventricle global longitudinal [LV, RV GLS], left atrial strain) with a prognostic role in HF.

We conducted a prospective cohort study on 105 patients with HF admitted to a center specialized in CR programs. Based on functional status at enrolment assessed on the NYHA class, we divided the patients into two groups: with mild and moderate functional limitation (NYHA I-II class) (n=70) and with severe functional limitation (NYHA III class) (n=35) respectively.

We analyzed demographics, anthropometrics, clinical and paraclinical parameters, with a focus on echocardiographic parameters of biventricular and atrial systolic function. Both at enrollment and at the 6-month assessment, functional status was assessed by cardiopulmonary exercise testing (CPET). At the 6-month follow-up patients in the second group had superior improvement in biological (p=0.039 for NT-proBNP) and echocardiographic parameters (p=0.041 for LV GLS, p=0.035 for RV GLS, p=0.017 for left atrial strain) compared to baseline. In the second group, LV GLS values were statistically significantly correlated with NT-proBNP (p=0.023), peak oxygen uptake (p=0.041) and maximum walking distance (p=0.031). RV GLS also positively correlated with peak oxygen uptake (p=0.017) at the follow-up. Receiver operating characteristic (ROC) curve analysis demonstrated that biventricular and atrial systolic function parameters amelioration are echocardiographic predictors for increased cardiorespiratory fitness. Lack of LV GLS and left atrial strain improvement in patients with severe functional limitation (group 2) is a negative predictor (AUC = 0.811, p = 0.015 for LV GLS and AUC = 0.649, p = 0.022 for left atrial strain).

CR programs improve systolic dysfunction and atrial function in HF patients. Improvement of LV and RV GLS as well as left atrial strain can be used as echocardiographic markers of better cardiorespiratory fitness 6 months after the start of the CR program.