الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 99 |  |  |
| | | from | 99 | | |
Abstract
The incidence of HFpEF is growing globally. Recent trials show that approximately 50 % of HF hospitalized patients have HFpEF. The prevalence of HFpEF in an Egyptian cohort of hospitalized patients with heart failure was 22%. Women were more likely to present with HFpEF than were men (29.7% vs. 10.6%, P < 0.001). Although current pharmacological and device therapies showed beneficial effects in HFrEF patients regarding reduction in mortality, morbidity, hospitalization and improvement of quality of life, they failed to show the same beneficial effects in HFpEF patients especially mortality reduction. (2,3)
ET based CR is documented to have beneficial effects among HFrEF patients in the form of better QOL and exercise capacity. Recently few randomized controlled trials including small number of patients showed beneficial impact of CR on HFpEF patients (133). In this study we aimed to evaluate the impact of CR added to the standard medical therapy versus standard medical therapy alone on the functional aspects (QOL and functional capacity) and the structural aspects (diastolic and systolic function parameters) of HFpEF patients.
This was a prospective randomized controlled study (1:1 randomization) conducted on 60 HFpEF patients. The inclusion criteria were established diagnosis of HFpEF defined according to the latest ESC guidelines. While the exclusion criteria were haemodynamically significant valvular disease, acute coronary syndrome as the primary diagnosis, end stage HF, severe CKD (eGFR<30 ml/min/1.73m2 or maintenance hemodialysis therapy), severe COPD or bronchial asthma, cognitive decline or major psychiatric pathology, non-ambulatory conditions and orthopedic problems interfering with exercise and life expectancy < 12 months.
Patients were divided into two groups group 1: included 30 HFpEF patients receiving CR plus usual medical care and group 2: included 30 HFpEF patients receiving usual medical care only.
• Data collection
Regarding demographic data, we registered age, gender, associated comorbidities such as HTN, DM, AFib, prior hospitalization with HF and smoking, the end points of the study were: NYHA class, TTE (with special focus on diastolic function assessment), QOL assessment using the MLWHFQ and 6MWT done at baseline and at the end of the study
• Exercise training based cardiac rehabilitation program:
The core rehabilitation program was as follows:
Mode of exercise: aerobic in nature on a treadmill, consisted of a 12 week program (2-3 sessions weekly). Each session lasted 15-60 minutes depending on patient’s physical work capacity (patients were exercised up to 40-75% of heart rate reserve based on maximum heart rate that was achieved during symptom limited exercise test prior to the initiation of the CR program.
The two groups were well matched regarding the baseline characteristics and demographic data.
group 1 showed significant improvement in the following:
a. MLWHFQ total score mean percentage of reduction 305.60 ± 158.44 versus vs 69.44 ± 17.71 (p<0.001).
b. E/e` mean percentage of reduction 65.96 ± 34.55 vs 18.23 ± 13.98 (p<0.001).
c. Left atrial volume index mean percentage of reduction 27.86 ± 13.27 vs 8.03 ± 4.40 (p<0.001).
d. Pulmonary artery systolic pressure mean percentage of reduction was 33.85 ± 14.68 vs 22.97 ± 16.54 (p=0.02).
e. Six–minute walk test percentage of increase 111.79 ± 40.97 vs 46.33 ± 11.58 (p<0.001).
f. Body mass index percentage of reduction 10.17 ± 3.64 vs 2.80 ± 1.60 (p<0.001).
g. Percentage of patients with down-grading of the grade of diastolic dysfunction 10 patients (33.3%) vs 3 patients (10%) (P=0.028).
h. Number of patients showing improvement in their NYHA functional class (p=0.006)
i. No significant difference in left ventricular ejection fraction or other parameters as E/A ratio, left atrial dimension, isovolumetric relaxation time, degree of left ventricular hypertrophy.
On reviewing the previous trials that have studied the impact of ET on HFpEF, large variation in the design and the results of those studies are found. (133) Our design with moderate intensity ET also was comfortable for the patients and helped our patients to complete all their rehabilitation sessions successfully
The limitations of this study are that it is a single center study and it did not include prolonged follow up. The echocardiographic measurements were done at rest and no measurements were done with exercise. However, we included reasonable number of patients who were representative, to a large extent, of the actual HFpEF demographics and epidemiology.
In the light of this study, we have shown that CR based on moderate duration of 12-week aerobic moderate intensity endurance ET program is beneficial, safe, and feasible with high patient compliance. CR can add significant positive impact on both the functional aspects with significant improvement in the QOL and the structural aspects with significant improvement of the diastolic function parameters. We recommend the addition of ET based CR as an essential part of the management strategy of HFpEF. The long term morbidity and mortality benefits of CR in HFpEF still need to be studied in further trials.