Noninvasive imaging assessment of rehabilitation therapy in heart failure with preserved and reduced left ventricular ejection fraction (IMAGING-REHAB-HF): design and rationale

Author(s):Show less -

Cardoso, Fernando Bianchini ^[1] ; Antunes-Correa, Ligia M. ^[1] ; Silva, Thiago Quinaglia A. C. ^[1] ; Silva, Luis Miguel ^[1] ; Toledo, Camilla ^[1] ; Ribeiro, Vinicius Citelli ^[1] ; Paim, Layde R. ^[1] ; Neilan, Tomas G. ^{[2, 3]} ; Velloso, Licio ^[1] ; Nadruz, Wilson ^[1] ; Ramos, Celso Dario ^[1] ; Dertkigil, Sergio S. ^[1] ; Schreiber, Roberto ^[1] ; Sposito, Andrei ^[1] ; Matos-Souza, Jose Roberto ^[1] ; Berwanger, Otavio ^[4] ; Jerosch-Herold, Michael ^[5] ; Coelho-Filho, Otavio Rizzi ^[6]

Affiliation

^[1] Univ Estadual Campinas, Fac Ciencias Med, Sao Paulo - Brazil

^[2] Harvard Med Sch, Cardiac MR PET CT Program, Div Cardiol, Massachusetts Gen Hosp, Boston, MA 02115 - USA

^[3] Harvard Med Sch, Dept Radiol, Massachusetts Gen Hosp, Boston, MA 02115 - USA

^[4] Hosp Israelita Albert Einstein, Inst Israelita Ensino & Pesquisa, Sao Paulo - Brazil

^[5] Brigham & Womens Hosp, Dept Radiol, Noninvas Cardiovasc Imaging Program, 75 Francis St, Boston, MA 02115 - USA

^[6] Univ Estadual Campinas, Discipline Cardiol, Dept Internal Med, UNICAMP, Hosp Clin, Rua Vital Brasil 251, Cidade Univ, BR-13083888 Campinas, SP - Brazil

• Document type: Journal article
• Source: THERAPEUTIC ADVANCES IN CHRONIC DISEASE; v. 10, AUG 2019.
• Web of Science Citations: 0

Abstract

Background: Studies have shown significant benefits of exercise therapy in heart failure (HF) with a reduced ejection fraction (HFrEF) and HF with a preserved ejection fraction (HFpEF). The mechanisms responsible for the beneficial effect of exercise in HFrEF and HFpEF are still unclear. We hypothesized that the effect of exercise on myocardial remodeling may explain its beneficial effect. Methods: IMAGING-REHAB-HF is a single-center, randomized, controlled clinical trial using cardiac magnetic resonance imaging, vasomotor endothelial function, cardiac sympathetic activity imaging and serum biomarkers to compare the effect of exercise therapy in HFpEF (LVEF >= 45%) and HFrEF (LVEF < 45%). Subjects will be assessed at baseline and after 4 months. The exercise program will consist of three 60-min exercise sessions/week. The primary endpoints are the effect of exercise on myocardial extracellular volume (ECV), left ventricular (LV) systolic function, LV mass, LV mass-to-volume and LV cardiomyocyte volume. Secondary endpoints include the effect of exercise on vasomotor endothelial function, cardiac sympathetic activity and plasmatic biomarkers. Patients will be allocated in a 2:1 fashion to supervised exercise program or usual care. A total sample size of 90 patients, divided into two groups according to LVEF:HFpEF group (45 patients:30 in the intervention arm and 15 in the control arm) and HFrEF group (45 patients:30 in the intervention arm and 15 in the control arm) - will be necessary to achieve adequate power. Conclusion: This will be the first study to evaluate the benefits of a rehabilitation program on cardiac remodeling in HF patients. The unique design of our study may provide unique data to further elucidate the mechanisms involved in reverse cardiac remodeling after exercise in HFpEF and HFrEF patients. (AU)

• FAPESP's process: 15/15402-2 - Characterization of interstitial fibrosis and cardiomyocyte hypertrophy by cardiac MRI: implication on early remodeling and on the transition to heart failure
• Grantee: Otávio Rizzi Coelho-Filho
• Support Opportunities: Research Grants - Young Investigators Grants