Article

In most patients with chronic heart failure (CHF), endurance training
improves exercise capacity. However, some patients do not respond favourably. The
purpose of this study was to explore the reasons of non-response and to determine
their predictive value. METHODS: We studied a cohort of 120 consecutive CHF
patients with sinus rhythm (mean age 57 +/- 12 years, ejection fraction 29.3 +/-
9.9%, peak VO(2) 17.3 +/- 5.1 ml/min/kg), participating in a 3-month outpatient
cardiac rehabilitation programme. Responders were defined as subjects who
improved peak VO(2) by more than 5%, work load by more than 10%, or VE/VCO(2)
slope by more than 5%. Subjects who did not fulfil at least one of the above
criteria were characterized as non-responders. Multivariate regression analyses
were performed to identify parameters that were predictive for a response.
Receiver operating characteristic (ROC) analyses were performed for predictive
parameters to identify thresholds for response or non-response. RESULTS:
Multivariate regression analyses revealed heart rate (HR) reserve, HR recovery at
1 min, and peak HR as significant predictors for a positive training response.
ROC curves revealed the optimal thresholds separating responders from
non-responders at less than 30 bpm for HR reserve, less than 6 bpm for HR
recovery and less than 101 bpm for peak HR. CONCLUSIONS: The presence of impaired
chronotropic competence is a major predictor of poor training response in CHF
patients with sinus rhythm.

Langue : ANGLAIS