Exercise Training Improves Diastolic Function in Heart Failure Patients

ALVES, A. J., F. RIBEIRO, E. GOLDHAMMER, Y. RIVLIN, U. ROSENSCHEIN, J. L. VIANA, J. A. DUARTE, M. SAGIV, and J. OLIVEIRA. Exercise Training Improves Diastolic Function in Heart Failure Patients. Med. Sci. Sports Exerc., Vol. 44, No. 5, pp. 776-785, 2012. Purpose: The study's purpose was to analyze the effects of exercise training on exercise tolerance and left ventricular systolic function and structure in heart failure patients with preserved, mild, and moderate to severe reduction of left ventricular ejection fraction (LVEF). Methods: Ninety-eight patients with moderate to severe (n = 34), mild (n = 33), and preserved (n = 31) LVEF were randomly assigned to exercise training plus usual care (n = 65) or usual care alone (n = 33) in a randomization ratio of 2:1. Left ventricular function, left ventricular dimensions, and exercise tolerance were assessed before and after each intervention. Results: Exercise tolerance and LVEF increased with exercise training in all patient groups, whereas they remained unchanged after usual care alone. Exercise training increased the mean ratio of early to late mitral inflow velocities (E/A ratio) and decreased deceleration time (DT) of early filling in patients with mild and preserved LVEF. In patients with moderate to severe systolic dysfunction and advanced diastolic dysfunction (DT < 160 ms), exercise training decreased E/A ratio and increased DT, both of which were unchanged after usual care alone. In the remaining patients (DT > 160 ms), exercise training also improved mitral inflow patterns. Exercise training decreased left ventricular dimensions in patients with mild and moderate to severe reduction of LVEF but not in patients with preserved LVEF. Conclusions: These results indicate that exercise training can improve the course of heart failure independent of the degree of baseline left ventricular dysfunction.