Article

Controlled exercise training (ET) is a valuable therapeutic addition
to pharmacological treatment in most patients with chronic heart failure (CHF),
reducing long-term mortality, preventing cardiac remodelling and improving
functional capacity. Despite the fact that the mechanism underlying its benefits
might be multifactorial, a sustained improvement in autonomic balance is usually
attributed as a major effect. Nevertheless, not all eligible subjects show the
same response to ET, probably due to several differences in the subpopulations
enrolled. We hypothesize that some heart rate variability (HRV) indexes could be
valid tools to optimize the selection and follow-up of CHF patients receiving ET
intervention. METHODS: Forty patients with CHF and left ventricular ejection
fraction (LVEF)</=40% under complete evidence-based pharmacological treatment
were included; 20 were assigned to a program of controlled ET on a 3-times/week
basis during 24 weeks, training group (TG) and 20 received a standard follow-up
program, control group (CG). In each patient, full clinical assessments,
echocardiography, HRV analysis and 6-minute-walk test were performed at the
beginning and the end of the study. RESULTS: After 24 weeks, patients in the TG
showed a significant improvement in LVEF, 6-minute walk test, functional class of
symptoms and HRV parasympathetic related indices (HF and rMSSD). Patients in the
CG did not exhibit any improvement in the aforementioned indices and experienced
more adverse events. Moreover, an initial value of HF<150 ms2/Hz or rMSSD<20ms
predicted better outcomes of the ET program, including improvements in systolic
function, the distance walked in 6minutes, and the functional class of symptoms,
along with a reduction in clinical events. CONCLUSIONS: In CHF patients, HRV
indexes related to parasympathetic function are valid and clinically useful tools
to select and follow-up those candidates that could experience superior
functional improvement after ET.
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Langue : ANGLAIS