Moderate Continuous or High Intensity Interval Exercise in Heart Failure with Reduced Ejection Fraction: Differences Between Ischemic and Non-ischemic Etiology

Overview

Journal Am Heart J Plus

Specialty Cardiology & Vascular Diseases

Date 2024 Apr 1

PMID 38558910

Authors

Martin Halle

Eva Prescott

Emeline M Van Craenenbroeck

Paul Beckers

Vibeke Videm

Trine Karlsen

Patrick Feiereisen

Ephraim B Winzer

Norman Mangner

Martin Snoer

Jeffrey W Christle

Havard Dalen

Asbjorn Stoylen

Katrin Esefeld

Melanie Heitkamp

Bianca Spanier

Axel Linke

Oyvind Ellingsen

Charles Delagardelle

Affiliations

Soon will be listed here.

Abstract

Background: Exercise for heart failure (HF) with reduced ejection fraction (HFrEF) is recommended by guidelines, but exercise mode and intensities are not differentiated between HF etiologies. We, therefore, investigated the effect of moderate or high intensity exercise on left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and maximal exercise capacity (peak VO) in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM).

Methods: The Study of Myocardial Recovery after Exercise Training in Heart Failure (SMARTEX-HF) consecutively enrolled 231 patients with HFrEF (LVEF ≤ 35 %, NYHA II-III) in a 12-weeks supervised exercise program. Patients were stratified for HFrEF etiology (ICM versus NICM) and randomly assigned (1:1:1) to supervised exercise thrice weekly: a) moderate continuous training (MCT) at 60-70 % of peak heart rate (HR), b) high intensity interval training (HIIIT) at 90-95 % peak HR, or c) recommendation of regular exercise (RRE) according to guidelines. LVEDD, LVEF and peak VO were assessed at baseline, after 12 and 52 weeks.

Results: 215 patients completed the intervention. ICM (59 %; n = 126) compared to NICM patients (41 %; n = 89) had significantly lower peak VO values at baseline and after 12 weeks (difference in peak VO 2.2 mL/(kg*min); p < 0.0005) without differences between time points (p = 0.11) or training groups (p = 0.15). Etiology did not influence changes of LVEDD or LVEF (p = 0.30; p = 0.12), even when adjusting for sex, age and smoking status (p = 0.54; p = 0.12). Similar findings were observed after 52 weeks.

Conclusions: Etiology of HFrEF did not influence the effects of moderate or high intensity exercise on cardiac dimensions, systolic function or exercise capacity.

Clinical Trial Registration–url: http://www.clinicaltrials.gov. Unique identifier: NCT00917046.

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