Exercise-Based Cardiac Rehabilitation Improves Exercise Capacity Regardless of the Response to Cardiac Resynchronization Therapy in Patients with Heart Failure and Reduced Ejection Fraction

Kayo Misumi, Michio Nakanishi, Hiroyuki Miura, Ayumi Date, Tatsuo Tokeshi, Leon Kumasaka, Tetsuo Arakawa, Kazuhiro Nakao, Takuya Hasegawa, Shigefumi Fukui, Masanobu Yanase, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Yoichi Goto

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Abstract

Background: In patients with chronic heart failure with reduced ejection fraction (HFrEF), cardiac resynchronization therapy (CRT) improves left ventricular ejection fraction (LVEF) and exercise-based cardiac rehabilitation (ECR) enhances exercise capacity. This study examined the relationship between the 2 responses. Methods and Results: Sixty-four consecutive HFrEF patients who participated in a 3-month ECR program after CRT were investigated. Patients were categorized according to a median improvement in peak oxygen uptake (PV O2) after ECR of 7% as either good (n=32; mean percentage change in PV O2 [%∆PV O2]=23.2%) or poor (n=32; mean %∆PV O2=2.5%) responders. There was no significant difference in baseline characteristics between the good and poor responders, except for PV O2 (51% vs. 59%, respectively; P=0.01). The proportion of good CRT responders was similar between the good and poor responders (%∆LVEF ≥10%; 53% vs. 47%, respectively; P=NS). Overall, there was no significant correlation between %∆LVEF after CRT and %∆PV O2 after ECR. Notably, among poor CRT responders (n=32), the prevalence of atrial fibrillation (0% vs. 29%; P<0.03) and baseline PV O2 (48% vs. 57%; P<0.05) were significantly lower among those with a good (n=15) than poor (n=17) response to ECR. Conclusions: In patients with HFrEF, good ECR and CRT responses are unrelated. A good PV O2 response to ECR can be achieved even in poor CRT responders, particularly in those with a sinus rhythm or low baseline PV O2.

Original languageEnglish
Pages (from-to)49-57
Number of pages9
JournalCirculation Journal
Volume86
Issue number1
DOIs
Publication statusPublished - 2022

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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