Unit:
Κατεύθυνση Κλινική Εργοσπιρομετρία, Άσκηση και ΑποκατάστασηLibrary of the School of Health Sciences
Supervisors info:
Σεραφείμ Νανάς, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Βασιλειάδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Χρυσανθόπουλος, Ε.Ε.Π., Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Συστηματική ανασκόπηση: Επίδραση του προγράμματος αποκατάστασης στη διαστολική λειτουργία στους ασθενείς με καρδιακή ανεπάρκεια με διατηρημένο κλάσμα εξώθησης
Translated title:
Systematic review: Effects of rehabilitation program on diastolic function in heart failure with preserved ejection function
Summary:
ΑBSTRACT
BACKGROUND: Twenty six million people worldwide suffer from heart failure, which remains one of the basic causes of death despite the current treatment. About 50% of patients with heart failure have preserved ejection fraction and the prevalence of HFpEF is approximately 1.5 – 5.5% of the general population. The pathophysiology has not been fully clarified and mechanisms which concern all the cardiac cavities, the systolic and diastolic function, the vessels and the microvasculature and the skeletal muscles are implicated. The diagnosis of HFpEF relies on the medical history, the echocardiogram which determines the diastolic function and the natriuretic peptides. Therefore none pharmaceutical intervention improves the symptoms, hospitalizations and prognosis of the patients because of the heterogeneity of its nature. Exercise through structured cardiac rehabilitation program improves the aerobic capacity and the quality of life of the patients with HFpEF.
OBJECTIVE: To investigate the impact of exercise on the diastolic dysfunction of patients with HFpEF.
METHODS: A systematic review was conducted on electronic databases PubMed, PEDRO and CENTRAL in order to identify randomized trials that have been published until December 2020 evaluating the effect of exercise on diastolic function in patients with HFpEF. The search terms were diastolic function, diastolic dysfunction, diastolic heart failure, heart failure with preserved ejection fraction, exercise, training and cardiac rehabilitation. Trials that were not written in English were excluded. The systematic review was carried out in accordance to PRISMA guidelines and the quality assessment was conducted according to the PEDro scale.
RESULTS: The literature review resulted in a total of 400 studies from which 7 were judged to be eligible, according to the inclusion and exclusion criteria that have been set. The average age of the participants was 65 years old and the majority was obese (ΒΜΙ>30kg/m2), stage ΝΥΗΑ ΙΙ/ΙΙΙ and arterial hypertension was the most frequent comorbidity. The training program consisted mainly of aerobic exercise with walking or cycling. The duration of the exercise varied from 20 to 60 minutes and its frequency was 3 times/week with the total duration of the intervention 12 – 24 weeks. Moderate-intensity aerobic exercise was implemented in the majority of the studies. Exercise seems to have no effect in the majority of the echocardiographic diastolic indices. E wave, A wave and isovolumic relaxation time were not improved in none of the studies. E/A ratio, deceleration time of E wave and early diastolic mitral annular velocity e’ were improved only in one study but in the rest of the trials exercise had no impact. Some key studies have a positive effect on filling pressures as assessed by E/e’ ratio. LAVI was investigated in one only study.
CONCLUSIONS: Exercise in patients with HFpEF improves the aerobic capacity and the quality of life without however clear indications that improves the diastolic function. Probably exercise has a positive impact in filling pressures of left ventricle. Mechanisms concerning the chronotropic incompetence and the skeletal muscles may be implicated in the positive effect of exercise in HFpEF patients. However, the findings of this systematic review must be interpreted cautiously as further research is needed to draw safe conclusions.
Main subject category:
Health Sciences
Keywords:
Diastolic function, Diastolic dysfunction, Exercise, Training, Cardiac rehabilitation, Diastolic heart failure, Heart failure with preserved ejection fraction
