Impact of combined exercise on function diastolic of patients with heart failure and reduced ejection fraction

Author(s)

Tainá Fabri Carneiro Valadão

• Document type: Master's Dissertation
• Press: Botucatu. 2016-04-18.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu
• Defense date: 2016-02-25
• Advisor: Meliza Goi Roscani; João Carlos Hueb

Abstract

The favorable effects of a combined exercise program (CEP) in patients with heart failure (HF) and reduced left ventricular ejection fraction (RLVE) are well recognized in the literature. There is consensus that physical exercise (PE) improves quality of life (QOL) and functional capacity (FC) in patients with HF. It is believed that the beneficial effects of PE are not due to the improvement of LVEF. On the other hand, some studies indicated beneficial effects of PE on LV diastolic function. Given the importance of LV filling pressure in symptoms of HF patients, the hypothesis of this study was that an CEP supervised program should promote improvement in diastolic function in patients with HF with LVEF <50% and this effect may be associated with decreased symptoms, reflecting improvement in FC and QOL in these patients. Objective: evaluate the effect of ECF in diastolic function in patients with reduced LVEF IC and investigate whether the improvement in diastolic function is r associated with improvement in symptoms, functional capacity and quality of life of these patients. Methodology: Prospective clinical trial, randomized and controlled, which included patients with HF and LVEF <50%, above 18 years. The sample consisted of 42 patients, divided into two groups matched for age and sex: the control group (CG) n = 20 - submitted to prescription in clinical practice of regular physical activity, not supervised. Intervention group (IG) n = 22 - underwent a physical exercise program supervised composed of aerobic exercise supplemented by resistance exercise 3 times a week for 12 weeks. Patients in both groups were initially submitted and after 12 weeks of research to clinical and physical evaluation, 12-minute walk test, transthoracic echocardiography, assessment of cardiac autonomic control and QoL questionary. Statistical analysis: test "t" was performed of the results of the differences between after and before moments of protocol comparing the two groups, or Mann Whitney test for data with non-normal distribution. Correlation test was used for variable associations of the same group. Results: In relation to clinical variables, only the blood pressure in IG (p = 0.022) showed a significant difference to the CG.). During the initial evaluation of the study, the dyspnea symptom was present in 60% in the control group and 45% in IG, p = 0.72, and chest pain 30% in CG and 22% in IG, p = 0.36. At the end of the study, both the symptom of dyspnea (10% in IG and 53% in the control group, p = 0.01) and chest pain (0.0% in IG and 20% in the control group, p = 0.02) decreased significantly in IG and did not change in the CG. Regarding the morphological and functional echocardiographic variables, significant differences were observed only in ejection fraction variable (p = 0.049) in IG at the end of the research protocol. Patients of IG showed improvement in FC, as measured by peak VO2 in METS compared to CG at the end of the study (p = 0.001). At the end of the protocol, there was significant improvement in four of the eight dimensions of QOL questionnaire in IG compared to CG: physical functioning (p<0.001), physical role functioning (p<0.001), general health perceptions (p<0.001) and vitality (p<0.001). It was also observed positive relationship between the FC and three dimensions evaluated in the SF-36 questionnaire: vitality (R=0,459, R2= 0,211 e P= 0,036), social role functioning (R= 0,510, R2= 0,260 e P= 0,018) and emotional role functioning (R= 0,529, R2= 0,279 e P= 0,014). Regarding the analysis of heart rate variability domain (HRV), there was improvement of the parasympathetic component (high-frequency band in normalized units; p = 0.016) and reduction in the low frequency band in units normalized in GI after the program exercise (p = 0.036) in orthostatic position. The CG had 3 patients with unfavorable outcomes (1 patient with cardiovascular mortality and 2 patients with newly diagnosed atrial fibrillation) and IG group did not course with unfavorable outcomes during the protocol. (p = 0.058). Discussion and Conclusion: CEP program supervised for 12 weeks in patients with HFREF is able to promote favorable impact on symptoms, blood pressure, exercise tolerance and QOL, which is independent of heart morphological changes. Diastolic function is not the main responsible for these benefits promoted by the exercise. The IG group, tended to less unfavorable outcomes in this protocol period, when compared to the control group. (AU)

• FAPESP's process: 13/24607-1 - IMPACT OF COMBINED EXERCISE IN DIASTOLIC FUNCTION OF PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION
• Grantee: Tainá Fabri Carneiro Valadão
• Support Opportunities: Scholarships in Brazil - Master