The role of non invasive central hemodynamics in patients with heart failure at cardiac rehabilitation

Background: Heart failure is a complex clinical syndrome in which the heart’s ability to pump blood around the body is reduced1. Central hemodynamics is an important factor to be considered for the individuals with heart failure. Disturbance of ventricular functions can worsen heart failure symptoms, impair independence, reduce quality of life and lead to increased health care utilization in patients with heart failure. Previous studies have identified exercise as a possible treatment for impaired ventricular function without other cardiac disease; however, there is limited evidence for the effect of this form of treatment in patients with heart failure. Aim: The primary aim of this study was to examine the effect of a supervised, out patient based exercise training programme on noninvasive central hemodynamics in patients with heart failure. Secondary aims were to examine the reproducibility of the Non invasive Cardiac system and find the effect of exercise on functional capacity, echocardiographic measures and quality of life. Methods: The participants for the study was enrolled from IRCCS San Raffaelle Pisana, Rome, Italy. Patients diagnosed with heart failure in outpatients department for cardiac rehabilitation, who met eligibility criteria, were recruited. Participants were screened by a Cardiac Rehabilitation Specialist at each sessons to ensure exercise safety prior to study enrolment. Demographic data, medical history, medications, functional capacity (six minute walk test), echocardiography parameters (Tricuspid Annular Plane Systolic Excursion, Ejection Fraction), Sort Form-36 Quality of Life Questionnaire and Kansas City Cardiomyopathy Questionnaire were repeated at Baseline and after 8 weeks. We enrolled 50 patients (42 men and 8 women, Mean age 64+9 Years) diagnosed with chronic heart failure.This was a prospective, single-center study. The intervention consisted of 1 hour of aerobic interval training about thrice a week. Program were designed and supervised by Cardiac Rehabilitation Physiotherapists. The primary outcome measure was a change in central hemodynamics measured by Non invasive cardiac system and secondary outcome measure was chages in echocardiographic parameters, six minute walk test and quality of life parameters. Results: The study participants reported significantly greater clinical improvement in central hemodynamics of Stroke Volume (P = 0.005), Cardiac Output (P = 0.054), Stroke Index (P = 0.003), Cardiac Index (P= 0.035), Heart Rate (P= 0.011) Cardiac Power index (p = 0.004) and Granov Goor Index (P= 0.001).These participants also had significant improvements in six minute walk test (p = 0.000), Tricuspid Annular Plane Systolic Excursion (P=0.017), Ejection Fraction (P= 0.001) and Short Form-36 Quality of Life questionnaire (P= 0.001) and also significantly improvement in clinical course of disease byKansas City Cardiomyopathy Questionnaire (P= 0.001). Conclusion: Eight weeks of supervised, outpatient based, aerobic interval training can improve the Non invasive central hemodynamics, echocardiographic parameters, functional capacity and Quality of life in patients with heart failure. According to our study results, the exercise training, part of cardiac rehabilitation is an important component of therapy in patients with Heart failure.