Article

Patients suffering from heart failure (HF) may demonstrate an abnormal
blood pressure response to exercise (ABPRE), which may revert to a normal one
following medical treatment. It is assumed that this change correlates positively
with prognosis and functional aspects. The aim of this study was to characterize
patients with ABPRE and assess ABPRE normalization and the correlation with
clinical and functional outcomes. Methods In the study,
651 patients with HF who
underwent cardiac rehabilitation (CR) were examined. Patients who presented an
ABPRE during stress testing were identified and divided into those who corrected
their initial ABPRE following CR and those who did not. Results
Pre-rehabilitation ABPRE was present in 27% of patients, 68% of whom normalized
their ABPRE following CR. Two parameters were independently predictive of failure
to normalize the blood pressure response: female gender (odds ratio (OR) 3.5; 95%
confidence interval (CI) 1.4-9.0) and decreased systolic function (OR 3.2; 95% CI
1.0-9.4). Patients with hypertrophic cardiomyopathy demonstrated higher rates of
ABPRE normalization than patients with other causes of HF (93% vs. 62%,
respectively, P = 0.03). The research population exhibited an average improvement
in exercise capacity (4.7 to 6.4 metabolic equivalents (METS), P < .001),
ejection fraction (35.4% to 37.7%, P < .001) and percentage of patients with New
York Heart Association (NYHA) class 3-4 (50% to 43.4%, P = .123). The group who
normalized their ABPRE exhibited greater improvement. Conclusions Amongst a
population of patients suffering from HF, an ABPRE was normalized following CR in
two thirds of patients. Female gender and a reduced systolic function
independently predicted the failure to correct the ABPRE, while patients with
hypertrophic cardiomyopathy demonstrated exceptionally high rates of
normalization.

Langue : ANGLAIS