Fitness impact on left ventricle GLS and left atrial strain in cardiac rehabilitation of heart failure patients

Cardiac rehabilitation (CR) is an essential pillar of the management of patients with heart failure (HF), regardless of the degree of systolic dysfunction, having both a therapeutic and prognostic role. The improvement of symptoms and functional status together with the improvement of quality of life are some of the arguments that support the referral of all HF patients to centers specialized in such integrative, multidisciplinary programs.

We aimed to evaluate the impact of physical training on echocardiographic parameters (left ventricle global longitudinal strain [LV GLS], left atrial strain) among HF patients on a CR program.

We conducted a prospective cohort study on 105 patients with HF admitted to a single tertiary referral center. According to the functional class assessed by cardiopulmonary exercise testing (CPET), we divided patients into two groups: mild to moderate functional limitation (n=46) and moderate-severe functional limitation (n=59).

We analyzed demographics, anthropometrics, clinical and paraclinical parameters, focusing on echocardiographic parameters of systolic function (ejection fraction, LV GLS) and atrial function (left atrial strain). Patients with HF in the second group had lower mean values of EF (p=0.046), LV GLS (p=0.021) and left atrial strain (p=0.039). After completing the CR program, patients in the second group had an improvement of the parameters compared to baseline values. LV GLS and left atrial strain values were statistically significantly correlated with serum NT-proBNP values (p=0.009), peak oxygen uptake (p=0.013), pain-free walking distance (p=0.034) and maximum walking distance (p=0.029). Left atrial strain also positively correlates with peak oxygen uptake (p=0.047). GLS value less than -8.9% is also a predictor for the persistence of severe functional limitation in HF patients (AUC=0.648 , p=0.041) (Figure 1).

CR program improves systolic dysfunction in HF patients, with low GLS values being a negative predictor of functional status.