Long-term myocardial adaptations after cardiac rehabilitation in heart failure: a randomized six-year evaluation using magnetic resonance imaging

Abstract

Objective: To assess exercise capacity and left ventricular function using magnetic resonance imaging (MRI) among patients with chronic heart failure randomized to a residential rehabilitation programme at baseline and six years after participation.

Design: Randomized controlled study.

Setting: Residential cardiac rehabilitation centre and community hospital. Intervention: One month of intensive exercise and risk reduction therapy including educational sessions, a low-fat diet, and 2 hours of individually prescribed exercise daily. Control subjects received usual care. Subjects were evaluated at baseline, after completing the one-month residential programme and six years later.

Subjects: From an original study group of 50, 16 patients (8 exercise, 8 controls) with chronic heart failure were alive and available for evaluation after six years.

Main measures: Cardiopulmonary exercise test responses and ventricular size and function using MRI.

Results: Peak Vo₂ was 20.0 and 12.4% higher after the rehabilitation programme and six years later, respectively, whereas minimal changes were observed among controls. Left ventricular mass and volumes tended to decrease among subjects in the exercise group, whereas left ventricular mass and volumes tended to increase among control subjects after six years. Ejection fraction increased approximately 20% in both groups.

Conclusion: Six years after participation in a concentrated residential rehabilitation programme, exercise capacity was preserved and no significant changes were observed in ventricular size or function. These findings provide further support for exercise rehabilitation in chronic heart failure.

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References

Pina IL , Apstein CS , Balady GJ et al. Exercise and heart failure: a statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention. Circulation 2003; 107: 1210-25.

McKelvie RS Exercise training in patients with heart failure: clinical outcomes, safety, and indications. Heart Failure Rev 2008; 13: 3-11.

Meyer T. , Kindermann M. , Kindermann W. Exercise programmes for patients with chronic heart failure. Sports Med 2004; 34: 939-54.

Collaborative ExTraMATCH. Exercise training meta-analysis of trials in patients with chronic heart failure . BMJ 2004; 328: 189-96.

Smart N. , Marwick TH Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med 2004; 116: 693-706.

Jugdutt BI , Michorowski BL , Kappagoda CT Exercise training after anterior Q wave myocardial infarction: importance of regional left ventricular function and topography. J Am Coll Cardiol 1988; 12: 362-72.

Ko JK , McKelvie RS The role of exercise training for patients with heart failure. Eur Med Phys 2005; 41: 35-47.

Mezzani A. , Corra U. , Giannuzzi P. Central adaptations to exercise training in patients with chronic heart failure . Heart Failure Rev 2008; 13: 13-20.

Dubach P. , Myers J. , Dziekan G. et al. Effects of exercise training on myocardial remodeling in patients with reduced left ventricular function after myocardial infarction. Circulation 1997; 95: 2060-67.

10.

Mueller L. , Myers J. , Kottman W. et al. Exercise capacity, physical activity patterns, and outcomes six years after cardiac rehabilitation in patients with heart failure. Clin Rehabil 2007; 21: 923-31.

11.

Boesch C. , Myers J. , Habersaat A. , Ilarraza H. , Kottman W. , Dubach P. Maintenance of exercise capacity and physical activity patterns 2 years after cardiac rehabilitation. J Cardiopulm Rehabil 2005; 25: 14-23.

12.

Borg GAV. Borg’s perceived exertion and pain scales . Champaign, IL, Human Kinetics , 1998.

13.

Myers J. , Buchanan N. , Walsh D. et al. Comparison of the ramp versus standard exercise protocols. J Am Coll Cardiol 1991; 17: 1334-42.

14.

Kwong RY , Korlakunta H. Diagnostic and prognostic value of cardiac magnetic resonance imaging in assessing myocardial viability. Top Magn Reson Imaging 2008; 19: 15-24.

15.

Fleg JL , Morel CH , Bos AG et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation 2005; 112: 674-82.

16.

Sibley CT , Lima JA Assessment of ventricular structure and function with multidetector CT and MRI. Curr Cardiol Rep 2008; 10: 67-71.

17.

Myers J. , Wagner D. , Schertler T. et al. Effects of exercise training on left ventricular volumes and function in patients with nonischemic cardiomyopathy: Application of magnetic resonance myocardial tagging. Am Heart J 2002; 144: 719-25.

18.

Otsuka Y. , Takaki H. , Okano Y. et al. Exercise training without ventricular remodeling in patients with moderate to severe left ventricular dysfunction early after acute myocardial infarction. Int J Cardiol 2003; 87: 237-44.

19.

Witham MD , Argo IS , Johnston DW , Struthers AD , McMurdo ME Long-term follow-up of very old heart failure patients enrolled in a trial of exercise training. Am J Geriatr Cardiol 2007; 16: 243-48.

20.

Tenenbaum A. , Freimark D. , Ahron E. et al. Long-term versus intermediate-term supervised exercise training in advanced heart failure: effects on exercise tolerance and mortality. Int J Cardiol 2006 ; 113: 364-70.

21.

Hagerman I. , Tyni-Lenne R. , Gordon A. Outcome of exercise training on the long-term burden of hospitalization in patients with chronic heart failure. A retrospective study. Int J Cardiol 2005; 98: 487-91.