Impact of Exercise Training on Peak Oxygen Uptake and its Determinants in Heart Failure with Preserved Ejection Fraction

Although the burden of heart failure with preserved ejection fraction (HFpEF) is increasing, there is no therapy available that improves prognosis. Clinical trials using beta blockers and angiotensin converting enzyme inhibitors, cardiac-targeting drugs that reduce mortality in heart failure with reduced ejection fraction (HFrEF), have had disappointing results in HFpEF patients. A new “whole-systems” approach has been proposed for designing future HFpEF therapies, moving focus from the cardiomyocyte to the endothelium. Indeed, dysfunction of endothelial cells throughout the entire cardiovascular system is suggested as a central mechanism in HFpEF pathophysiology. The objective of this review is to provide an overview of current knowledge regarding endothelial dysfunction in HFpEF. We discuss the molecular and cellular mechanisms leading to endothelial dysfunction and the extent, presence, and prognostic importance of clinical endothelial dysfunction in different vascular beds. We also consider implications towards exercise training, a promising therapy targeting system-wide endothelial dysfunction in HFpEF.

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Peak Exercise and Post‐Exercise Recovery Oxygen Uptake and Muscle Oxygenation in Patients with Heart Failure and Preserved Ejection Fraction and Healthy Matched Adults

The FASEB Journal ◽

10.1096/fasebj.2019.33.1_supplement.lb461 ◽

2019 ◽

Vol 33 (S1) ◽

Author(s):

Natasha Boyes ◽

Janine Eckstein ◽

Stephen Pylypchuk ◽

Dana Lahti ◽

Scotty J Butcher ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Oxygen Uptake ◽

Muscle Oxygenation ◽

Peak Exercise ◽

Exercise Recovery ◽

Preserved Ejection Fraction ◽

Post Exercise ◽

Patients With Heart Failure ◽

Post Exercise Recovery

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Exercise Training and Heart Failure with Preserved Ejection Fraction: What the Evidence of the Studies Show?

Translational Medicine ◽

10.4172/2161-1025.1000e1334 ◽

2015 ◽

Vol 05 (04) ◽

Author(s):

Leonardo Roever

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Ejection Fraction ◽

Preserved Ejection Fraction

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Effects of exercise training in heart failure with preserved ejection fraction: an updated systematic literature review

Heart Failure Reviews ◽

10.1007/s10741-019-09841-x ◽

2019 ◽

Vol 25 (5) ◽

pp. 703-711 ◽

Cited By ~ 2

Author(s):

Massimo Leggio ◽

Augusto Fusco ◽

Claudia Loreti ◽

Giorgio Limongelli ◽

Maria Grazia Bendini ◽

...

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Literature Review ◽

Ejection Fraction ◽

Systematic Literature Review ◽

Preserved Ejection Fraction

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Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction

International Journal of Angiology ◽

10.1055/s-0038-1676836 ◽

2019 ◽

Vol 28 (01) ◽

pp. 044-049

Author(s):

Sidhi Purwowiyoto ◽

Budhi Purwowiyoto ◽

Amiliana Soesanto ◽

Anwar Santoso

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Exercise Training ◽

Ejection Fraction ◽

Left Ventricular ◽

World Health ◽

Volume Index ◽

Lv Function ◽

Preserved Ejection Fraction

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.

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Risk stratification in heart failure with mild reduced ejection fraction

European Journal of Preventive Cardiology ◽

10.1177/2047487320951104 ◽

2020 ◽

Vol 27 (2_suppl) ◽

pp. 59-64

Author(s):

Damiano Magrì ◽

Giovanna Gallo ◽

Gianfranco Parati ◽

Mariantonietta Cicoira ◽

Michele Senni

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Oxygen Uptake ◽

Risk Stratification ◽

Exercise Test ◽

Peak Oxygen Uptake ◽

Cardiopulmonary Exercise Test ◽

Recent Contribution ◽

Reduced Ejection Fraction ◽

Cardiopulmonary Exercise

Heart failure with mid-range ejection fraction represents a heterogeneous and relatively young heart failure category accounting for nearly 20–30% of the overall heart failure population. Due to its complex phenotype, a reliable clinical picture of heart failure with mid-range ejection fraction patients as well as a definite risk stratification are still relevant unsolved issues. In such a context, there is growing interest in a comprehensive functional assessment by means of a cardiopulmonary exercise test, yet considered a cornerstone in the clinical management of patients with heart failure and reduced ejection fraction. Indeed, the cardiopulmonary exercise test has also been found to be particularly useful in the heart failure with mid-range ejection fraction category, several cardiopulmonary exercise test-derived parameters being associated with a poor outcome. In particular, a recent contribution by the metabolic exercise combined with cardiac and kidney indexes research group showed an independent association between the peak oxygen uptake and pure cardiovascular mortality in a large cohort of recovered heart failure with mid-range ejection fraction patients. Contextually, the same study supplied an easy approach to identify a high-risk heart failure with mid-range ejection fraction subset by using a combination of peak oxygen uptake and ventilatory efficiency cut-off values, namely 55% of the maximum predicted and 31, respectively. Thus, looking at the above-mentioned promising results and waiting for specific trials, it is reasonable to consider cardiopulmonary exercise test assessment as part of the heart failure with mid-range ejection fraction work-up in order to identify those patients with an unfavourable functional profile who probably deserve a close clinical follow-up and, probably, more aggressive therapeutic strategies.

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Chronic interval exercise training prevents BKCa channel-mediated coronary vascular dysfunction in aortic-banded miniswine

Journal of Applied Physiology ◽

10.1152/japplphysiol.01138.2017 ◽

2018 ◽

Vol 125 (1) ◽

pp. 86-96 ◽

Cited By ~ 8

Author(s):

T. Dylan Olver ◽

Jenna C. Edwards ◽

Brian S. Ferguson ◽

Jessica A. Hiemstra ◽

Pamela K. Thorne ◽

...

Keyword(s):

Heart Failure ◽

Exercise Training ◽

Ejection Fraction ◽

Vascular Dysfunction ◽

Pressure Overload ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Interval Exercise

Conventional treatments have failed to improve the prognosis of heart failure with preserved ejection fraction (HFpEF) patients. Thus, the purpose of this study was to determine the therapeutic efficacy of chronic interval exercise training (IT) on large-conductance Ca2+-activated K+ (BKCa) channel-mediated coronary vascular function in heart failure. We hypothesized that chronic interval exercise training would attenuate pressure overload-induced impairments to coronary BKCa channel-mediated function. A translational large-animal model with cardiac features of HFpEF was used to test this hypothesis. Specifically, male Yucatan miniswine were divided into three groups ( n = 7/group): control (CON), aortic banded (AB)-heart failure (HF), and AB-interval trained (HF-IT). Coronary blood flow, vascular conductance, and vasodilatory capacity were measured after administration of the BKCa channel agonist NS-1619 both in vivo and in vitro in the left anterior descending coronary artery and isolated coronary arterioles, respectively. Skeletal muscle citrate synthase activity was decreased and left ventricular brain natriuretic peptide levels increased in HF vs. CON and HF-IT animals. A parallel decrease in NS-1619-dependent coronary vasodilatory reserve in vivo and isolated coronary arteriole vasodilatory responsiveness in vitro were observed in HF animals compared with CON, which was prevented in the HF-IT group. Although exercise training prevented BKCa channel-mediated coronary vascular dysfunction, it did not change BKCa channel α-subunit mRNA, protein, or cellular location (i.e., membrane vs. cytoplasm). In conclusion, these results demonstrate the viability of chronic interval exercise training as a therapy for central and peripheral adaptations of experimental heart failure, including BKCa channel-mediated coronary vascular dysfunction. NEW & NOTEWORTHY Conventional treatments have failed to improve the prognosis of heart failure with preserved ejection fraction (HFpEF) patients. Our findings show that chronic interval exercise training can prevent BKCa channel-mediated coronary vascular dysfunction in a translational swine model of chronic pressure overload-induced heart failure with relevance to human HFpEF.

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