Right Ventricular Function and Beneficial Effects of Cardiac Rehabilitation in Patients With Systolic Chronic Heart Failure

Cardiac rehabilitation had an important role in the management of heart failure. The predictors of exercise capacity improvement after cardiac rehabilitation are required in the management of heart failure. We demonstrated that patients with higher right ventricular strain during preload augmentation seem to have a benefit more from cardiac rehabilitation. The simple, but novel application of preload stress echocardiography is a noninvasive technique that can be used to find a beneficial group with cardiac rehabilitation.

Background: It has been recognized that a comprehensive cardiac rehabilitation (CR) program improves mortality in patients with chronic heart failure (HF). On the other hand, the magnitude of the improvement in exercise capacity after CR differs among individuals. The aim of this study was to assess the echocardiographic determinants of responders to CR using preload stress echocardiography.
Methods: We prospectively enrolled 58 chronic HF patients with reduced left ventricular ejection fraction (LVEF) (age 62±11 years; 69% male; LVEF 43±7 %) who had received optimized medical treatment in a CR program for 5 months. We performed preload echocardiographic studies using leg positive pressure (LPP) to assess the echocardiographic parameters during preload augmentation. We defined 41 patients as a development cohort to assess the predictive value of echocardiographic variables. Next, we validated results in the remaining 17 patients as a validation cohort.
Results: In the development cohort, significant improvement in peak VO2 (>10%) after CR was observed in 58% patients. In a multivariable logistic regression model, the significant predictor of improvement in exercise capacity was right ventricular (RV) strain during LPP (odds ratio: 3.96 per 1 SD; p =0.01). A RV strain value of –16% during LPP had good sensitivity of 0.79 and specificity of 0.71 to identify patients with improvement in peak VO2. In the validation cohort, an optimal cut off value of RV strain value was the same (AUC: 0.77, sensitivity: 0.78, specificity: 0.65).
Conclusion: RV strain during LPP may be an echocardiographic parameter for assessing beneficial effects of CR.

© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/