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Cardiac rehabilitation and muscle efficiency improvement in heart failure patients
Session:
Comunicações Orais (Sessão 25) - Risco CV, Prevenção e Reabilitação Cardíaca 2 - Vários
Speaker:
Daniel A. Gomes
Congress:
CPC 2022
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel a. Gomes; Sérgio Maltês; Gonçalo Cunha; Gustavo s. Mendes; Mariana s. Paiva; Rita r. Santos; Luís Moreno; Anaí Durazzo; Jorge Ferreira; Miguel Mendes
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Introduction:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Cardiac rehabilitation programs (CRP) are known to improve functional capacity in heart failure (HF) patients. However, the underlying mechanisms by which CRP improves exercise tolerance are not yet fully understood. We hypothesize that increased muscle efficiency (ME), which is inversely proportional to oxygen consumption (VO2) for similar load conditions, may explain such benefits by optimizing energy use independently of muscle oxygen delivery.</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Methods:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Retrospective single-center study enrolling consecutive patients with chronic (>3 months) and stable HF with reduced ejection fraction (HFrEF <40%) under optimal medical therapy (including cardiac resynchronization therapy) who completed a phase 2 CRP from 2016 to 2021. Patients underwent four months of CRP as per site protocol, and all had a pre- and post-CRP cardiopulmonary exercise test (CPET) performed within one month before CRP start and two weeks after the end. Those who performed different exercise protocols in both CPETs were excluded (n=22). VO2 comparison for similar work conditions (eg. 25%, 50%, 75% and 100% of attained metabolic equivalent [METS] at first CPET) before and after CRP was used as a surrogate for ME. </span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Results:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Overall, 44 patients (mean age 61±11 years; 80% male; 66% with ischemic HF; median left ventricular ejection fraction of 30% [IQR 25-35]; 93% in NYHA class II-IV) were included. CPET was performed using standard Bruce or Ramp protocol in 20% and 80% of patients, respectively. A significant increase in exercise duration before and after CRP was detected (6.4 [IQR 5.2-7.1] vs. 9.3 [IQR 8.5-10.4] minutes, p <0.001), while no differences were found at peak VO2 and first ventilatory threshold levels. Oxygen consumption for similar workloads was significantly lower in the final CPET at both submaximal (25%, 50% and 75%) and peak exercise level (at 100% METS: 13.9 [11.1-18.2] vs. 16.3 [12.8-19.4] mL/kg; Wilcoxon signed ranks test Z = -4.08, p< 0.001) (figure 1). Those with ME increment ≥10% at peak exercise (n= 21, 48%) showed a higher exercise capacity improvement after CRP (median estimated METS increase between CPETs: 1.9 [1.2-2.6] vs. 1.0 [0.0-1.7], p=0.01).</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Conclusions:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">In a cohort of HFrEF patients, CRP increased ME by 14% at submaximal (25%, 50%, 75%) and at peak exercise level. These findings suggest that optimal muscle energy use may explain, at least partially, the functional capacity improvement observed after cardiac rehabilitation.</span></span></span></p>
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