Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Abstract

BackgroundSuccess of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO 2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular‐arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX‐derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.Methods and ResultsThirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise‐based CR. Noninvasive LV pressure‐volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO 2 was not in a significant correlation with the change in VAC (r=−0.18; P=0.31), mechanical efficiency (r=−0.16, P=0.39), or the change in ejection fraction (r=−0.07; P=0.68).Conclusions CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX‐derived data in predicting clinical outcomes.

The role of ventricular–arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association

“…Ventricular–arterial coupling may also be useful to assess response to various therapeutic approaches in chronic HF. Table summarizes various therapeutic strategies having beneficial effects on VAC in HFrEF …”

“…Lastly, cardiopulmonary rehabilitation on top of optimal treatment is associated with VAC and LV mechanical efficiency optimization in HFrEF patients with systolic HF. This beneficial effect is potentially multi‐factorial, including significant improvements in arterial compliance, peripheral resistance, wave reflections, skeletal muscle oxidative function, and arterial–venous oxygen difference …”

Arterial Ventricular Uncoupling With Age and Disease and Recoupling With Exercise

“…Similarly, 20 sessions of exercise-based cardiac rehabilitation in heart failure with reduced ejection fraction increased resting E A /E LV from 0.56+0.18 to 0.67+0.21 via a slight (9%) reduction in E A . As such, resting cardiac energetic efficiency was improved, i.e., the ratio of energy transferred to the arterial system (external work) to the energy consumed for this action (2). Collectively, exercise training induces significant CV adaptations during exercise in various populations with different severities of CV disease.…”

Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

“…Таким образом, лечение, направленное на улучшение взаимодействия сердца и сосудов, может влиять на прогрессирование сердечно-сосудистых заболеваний [8,9]. Так, у 42 пациентов с декомпенсацией СН было отмечено значимое улучшение ЛЖАС и эффективности работы ЛЖ на фоне терапии [10].…”