Impact of lifestyle modification on left ventricular function and cardiopulmonary exercise capacity in patients with heart failure with normal ejection fraction and cardiometabolic syndrome: a prospective interventional study.

Ritzel A; Otto F; Bell M; Sabin G; Wieneke H.

Acta Cardiologica. 70(1):43-50, 2015 Feb.

BACKGROUND: Heart failure with normal left ventricular ejection fraction
(HFNEF) accounts for about one third of all heart failure patients with
considerable mortality. The metabolic syndrome (MS) is a risk factor for
diastolic dysfunction and HFNEF. We hypothesized that modifying metabolic
burden by exercise training and weight loss might improve left ventricular
diastolic function, heart failure symptoms and rehospitalization rate.

METHODS AND RESULTS: Forty patients with HFNEF, MS and prediabetes were
enrolled in this prospective study. Echocardiography and cardiopulmonary
exercise testing (CPET) were done at baseline and after 3 months lifestyle
modification (LSM). NT-pro BNP and adiponectin were determined at baseline
as both peptidehormones play a crucial role in MS and heart failure. After
discharge a 3-month LSM program with the aim of weight reduction by diet
and exercise was started. After the intervention period a weight reduction
of >= 2% was defined as successful LSM (group A = 23 patients), while a
weight reduction < 2% was classified as unsuccessful LSM (group B = 17
patients). At baseline NT-pro BNP (424 +/- 381 versus 121 +/- 99 pg/ml, P
< 0.01) and adiponectin (10.1 +/- 6.2 versus 4.6-2.0 micro&#32;g/ml, P <
0.01) were higher in group A than in group B. After 3 months of LSM, CPET
showed a significant improve- ment of VO2 peak (P < 0.01), EqCO2 (P <
0.001), O2-pulse (P = 0.02) and VE / VCO2 slope (P = 0.01) in group A.
After one year of follow-up a modest but significant reduction of left
atrial size and mitral flow to mitral annulus velocity ratio E/E’ was seen
in group A. LSM resulted in significant improvement of NYHA status (P =
0.03) and higher freedom of rehospitalization (P = 0.04) in group A.

CONCLUSION: Successful lifestyle modification in obese, prediabetic
patients with HFNEF improves diastolic left ventricular function and
cardiopulmonary exercise capacity. As these measures result in improved
NYHA status and less hospitalization, LSM might be a promising approach to
prevent chronic diastolic heart failure.