Drug therapy optimization does not explain response status of exercise based cardiac rehabilitation among heart failure patients with reduced ejection fraction

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Lahouaoula, Z.E.A. | Leprêtre, Z. | Rouault-de Mangeon-Krim, A. | Alaoui, T. | Krim, F. | Leprêtre, P.-M.

Edité par CCSD ; Elsevier ; Société française de cardiologie [2008-....] -

International audience. IntroductionCardiac rehabilitation (CR) is a complex, interprofessional intervention customized to individual patients with heart failure (HF) (Tessler and Bordoni 2024). Based on exercise training and medicine optimization, the main CR goal is to improve the peak value of oxygen uptake (VO2peak), which is strongly linked to the vital prognostic of HF patients. A minimal clinically important difference (MCID) of 6% for VO2peak was proposed to discriminate responder (R) and no-responder (NR) HF patients to CR (Swang et al., 2012). Previous studies showed beneficial effects of exercise training or medicine on VO2peak (Montero and Flammer 2018, Taylor et al., 2019, Wu et al., 2022, Peng et al., 2023). Medicine effect on VO2peak could be explained by an increase in chronotropic response as evidenced by the improvement in Exercise Heart Rate Reserve (EHRR) (Efthimiadis et al., 2011). In our knowledge, there is a paucity of studies assessing the effect of drug therapy optimization on responder status to exercise training.ObjectiveThe study aimed to compare EHRR between R and NR patients with HF related to drug therapy.MethodA retrospective study was conducted in 47 HF patients with reduced ejection fraction who performed a cardiopulmonary exercise testing (CEPT) with oxygen uptake measurements before and after an exercise based cardiac rehabilitation program (ECR). The MCID value was fixed at 6% to differentiate R and NR patients to ECR.Results19 of 47 patients (40.4%) were NR vs. 28 patients were R (59.6%). AS illustrated in the Table 1, no significant difference was found between R and NR patients at the baseline. All the patients had a similar drug therapy optimization during ECR. ECR induced a significant increase in VO2peak in R patients whereas the peak VO2 values slightly decreased in NR patients. Our result showed that the modest increase in the mean value of exercise heart rate reserve for R patients and the no-significant EHRR decrease for NR patients were not related to drug therapy. Finally, R patients significantly improved physiological values associated with the first ventilatory threshold.ConclusionThe level of response to exercise based cardiac rehabilitation of patients presented a heart failure with reduced ejection fraction seemed independent to the drug therapy optimization.

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