Exercise Training in Heart Failure: structural and functional cardiac remodeling

在不断增长的老年人口中，收缩性心力衰竭(HF)的患病率很高。 进行性心脏重塑和心输出量恶化是关键因素。 潜在的心衰相关运动不耐受和生活质量1。即使在实施医疗和设备 适度重塑的治疗，运动耐量仍然受损。虽然运动训练一直是 尽管有证据表明可以提高运动能力，但促进这一益处的机制仍不清楚。外围 骨骼肌和血管系统的适应至少提供了一些好处，尽管心脏是反向的 重塑(超越药物和装置疗法的影响)可能是额外的4-6项。我们建议研究 两种不同运动方式对心脏形态及收缩、舒张期的影响 性能和相关功能收益。我们将把传统的有氧训练与一种新的养生方法进行比较 吸气肌训练(IMT)。IMT是一种特定类型的运动训练，可能对 虚弱、虚弱的心衰患者，他们不太可能耐受有氧训练。IMT对重塑的影响尚未见报道 已经被研究过了。 拟议的超声心动图试点研究建立在由VA Merit F0834-R资助的运动疗法基础上，以 减少心力衰竭症状；对不同模式进行比较的有益机制分类 老年(50岁)收缩期心衰(EFd40%)患者的运动训练。最初的研究评估了外围设备 运动训练影响的机制，但不是为评估心脏重构而设计的。建议数 先导研究提供了一个重要的补充分析，即它增加了对心脏重构的评估以及 收缩和舒张期功能的相关变化。男性和女性(N=75)收缩期心衰患者(LVEF) D40%)，年龄为50岁。患者将被随机分为三组(IMT[n=30]或 有氧组[n=30]或对照组[n=15])。一系列全面的功能评估以及 超声心动图检查将在为期12周、每周3次的有氧运动前后进行。 培训VS IMT VS常规护理。 具体目的是(1)分析运动训练对左心结构和功能的影响 传统的和新的收缩和舒张期功能指数。我们假设运动训练会 减少左心室舒张末和收缩末期容量，增加射血分数(EF)以及 与对照相比，地区性菌株。(B)运动训练可增加二尖瓣环舒张期早期血流速度(e‘)。 并降低二尖瓣早期血流速度(E)与E‘的比值(E/e’)。(C)IMT将不逊于 有氧训练在抗重构方面的益处，这两种训练形式都优于 控制。(2)。探讨改善心脏重构和生理学对心脏功能和功能的益处 定性端点。我们假设(A)运动训练相关的心脏改善将导致 改善有氧功能参数(VO2峰值和VE/VCO2斜率)。(B)与运动训练有关 心脏的改善将导致有氧功能参数的改善和生活质量的改善(AS 通过问卷测量)。

Prevalence of systolic heart failure (HF) is high among the growing population of older adults1-3. Progressive cardiac remodeling and deteriorating cardiac output have been implicated as key factors underlying HF-related exercise intolerance and quality of life1. Even after implementing medical and device therapies that moderate remodeling, exercise tolerance remains impaired. While exercise training has been demonstrated to improve exercise capacity, mechanisms facilitating this benefit remain unclear. Peripheral adaptations in the skeletal muscle and vasculature provide at least some benefit, however reverse cardiac remodeling (beyond effects of pharmacological and device therapies) may be additive4-6. We propose to study the impact of 2 different types of exercise on cardiac morphology as well as systolic and diastolic performance and related functional gains. We will compare traditional aerobic training to a novel regimen of inspiratory muscle training (IMT). IMT is a specific type of exercise training that may be particularly useful for frail, infirmed HF patients who are unlikely to tolerate aerobic training. Effects of IMT on remodeling have not been previously studied. The proposed echocardiography pilot study builds on a funded VA Merit F0834-R "Exercise Therapy to Reduce Heart Failure Symptoms; Sorting Mechanisms of Benefit" (PI, Forman) that compares different modes of exercise training in older (agee50yrs) systolic (EFd40%) HF patients. The original study assesses peripheral mechanisms affected by exercise training, but was not designed to assess cardiac remodeling. The proposed pilot study provides a vital complementary analysis, i.e., it adds assessments of cardiac remodeling as well as related changes in systolic and diastolic performance. Male and female (N=75) systolic HF patients (LVEF d40%) aged e50 years will be studied. Patients will be randomized into one of three groups (IMT [n=30] or aerobic [n=30] or control [n=15]). A comprehensive battery of functional assessments as well as echocardiographic examination will be performed before and after a 12-week, 3x/weekly regimen of aerobic training vs. IMT vs. usual care. Specific Aims are (1) to analyze exercise training effects on left ventricular structure and function using conventional and novel indices of systolic and diastolic function. We hypothesize that exercise training will decrease left ventricular end-diastolic and end-systolic volumes and increase ejection fraction (EF) as well as regional strain compared to controls. (b) exercise training will increase mitral annular early diastolic velocity (e') as well as decrease the ratio (E/e') of early mitral inflow velocity (E) and e'. (c) IMT will be non-inferior to aerobic training in relation to anti-remodeling benefit and both forms of training will be superior compared to controls. (2). To explore the benefits of improved cardiac remodeling and physiology on functional and qualitative endpoints. We hypothesize (a) that exercise training-related cardiac improvements will lead to improved aerobic functional parameters (peak VO2 and VE/VCO2 slope). (b) that exercise training-related cardiac improvements will lead to improved aerobic functional parameters and improved quality of life (as measured by questionnaires).