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Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials.

ABSTRACT: BACKGROUND:Heart failure with preserved ejection fraction (HFPEF) is common and characterized by exercise intolerance and lack of proven effective therapies. Exercise training has been shown to be effective in improving cardiorespiratory fitness (CRF) in patients with systolic heart failure. In this meta-analysis, we aim to evaluate the effects of exercise training on CRF, quality of life, and diastolic function in patients with HFPEF. METHODS AND RESULTS:Randomized controlled clinical trials that evaluated the efficacy of exercise training in patients with HFPEF were included in this meta-analysis. Primary outcome of the study was change in CRF (measured as change in peak oxygen uptake). Effect of exercise training on quality of life (estimated using Minnesota living with heart failure score), and left ventricular systolic and diastolic function was also assessed. The study included 276 patients who were enrolled in 6 randomized controlled trials. In the pooled data analysis, patients with HFPEF undergoing exercise training had significantly improved CRF (mL/kg per min; weighted mean difference, 2.72; 95% confidence interval, 1.79-3.65) and quality of life (weighted mean difference, -3.97; 95% confidence interval, -7.21 to -0.72) when compared with the control group. However, no significant change was observed in the systolic function (EF-weighted mean difference, 1.26; 95% confidence interval, -0.13% to 2.66%) or diastolic function (E/A-weighted mean difference, 0.08; 95% confidence interval, -0.01 to 0.16) with exercise training in patients with HFPEF. CONCLUSIONS:Exercise training in patients with HFPEF is associated with an improvement in CRF and quality of life without significant changes in left ventricular systolic or diastolic function.

SUBMITTER: Pandey A

PROVIDER: S-EPMC4792111 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials.

Pandey Ambarish A Parashar Akhil A Kumbhani Dharam D Agarwal Sunil S Garg Jalaj J Kitzman Dalane D Levine Benjamin B Drazner Mark M Berry Jarett J

Circulation. Heart failure 20141116 1

<h4>Background</h4>Heart failure with preserved ejection fraction (HFPEF) is common and characterized by exercise intolerance and lack of proven effective therapies. Exercise training has been shown to be effective in improving cardiorespiratory fitness (CRF) in patients with systolic heart failure. In this meta-analysis, we aim to evaluate the effects of exercise training on CRF, quality of life, and diastolic function in patients with HFPEF.<h4>Methods and results</h4>Randomized controlled cli ...[more]

PMID: 25399909

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Project description:BackgroundWhile exercise training (ET) is an established tool in heart failure (HF), no research to date has analysed the efficacy of ET in both preserved (HFpEF) and reduced (HFrEF) ejection fraction phenotypes across the same clinically important parameters.MethodsA comprehensive systematic search was performed to identify trials published between 1990 and May 2021. Controlled trials of adults reporting pre- and post-ET peak VO2, 6-min walk distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Kansas City Cardiomyopathy Questionnaire (KCCQ) and left ventricular ejection fraction (LVEF) were considered. Parameters of cardiac diastolic function, brain natriuretic peptides (BNP)/N-terminal prohormone of BNP (NTproBNP) and follow-up hospitalisation and mortality data were also analysed.ResultsNinety-three studies (11 HFpEF and 82 HFrEF) were included in the final analysis, with a pooled sample size of 11,081 participants. HFpEF analysis demonstrated significant improvements in peak VO2 (weighted mean difference: 2.333 ml·min-1·kg-1, Pfixed < 0.001), 6MWD (WMD: 35.396 m, Pfixed < 0.001), MLHFQ (WMD: - 10.932, Prandom < 0.001), KCCQ (WMD: 3.709, Pfixed = 0.037) and E/e' (WMD: - 1.709, [95% CI] = - 2.91-0.51, Prandom = 0.005). HFrEF analysis demonstrated significant improvements in peak VO2 (WMD: 3.050 ml·min-1·kg-1, Prandom < 0.001), 6MWD (WMD: 37.299 m, Prandom < 0.001), MLHFQ (WMD: - 10.932, Prandom < 0.001), LVEF (WMD: 2.677%, Prandom = 0.002) and BNP/NTproBNP (SMD: - 1.349, Prandom < 0.001). Outcome analysis was only performed in HFrEF, which found no significant changes in hospitalisation, all-cause mortality or composite end-points.ConclusionET significantly improves exercise capacity and quality of life in both HFpEF and HFrEF patients. In HFpEF patients, ET significantly improved an important index of diastolic function, with significant improvements in LVEF and NTproBNP/BNP seen in HFrEF patients only. Such benefits did not translate into significantly reduced hospitalisation or mortality after short-term follow-up.

Dataset Information

Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials.

Publications

Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials.

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