Improvement in Left Ventricular Diastolic Stiffness Induced by Physical Training in Patients With Dilated Cardiomyopathy

Gabriella Malfatto, Giovanna Branzi, Giuseppe Osculati, Paola Valli, Paola Cuoccio, Francesca Ciambellotti, Gianfranco Parati, Mario Facchini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Diastolic dysfunction in long-term heart failure is accompanied by abnormal neurohormonal control and ventricular stiffness. The diastolic phase is determined by a balance between pressure gradients and intrinsic ventricular wall properties: according to a mathematical model, the latter (ie, left ventricular [LV] elastance, KLV) may be calculated by the formula: KLV = (70/[DT-20])2 mm Hg/mL, where DT is the transmitral Doppler deceleration time. Methods and Results: In 54 patients with chronic systolic heart failure (39 men, 15 women; age 65 ± 10 years; New York Heart Association [NYHA], 2.3 ± 0.9; ejection fraction [EF], 32% ± 5%), we analyzed the relationship between KLV and an index of neurohormonal derangement (levels of brain natriuretic peptide [BNP]), and investigated whether 3 months of physical training could modulate diastolic operating stiffness. Patients were randomized to physical training (n = 27) or to a control group (n = 27). Before and after training, patients underwent Doppler echocardiogram and cardiopulmonary stress test. At baseline, ventricular stiffness was related to BNP levels (P <.01). Training improved NYHA class, exercise performance, and estimated pulmonary pressure. BNP was reduced. Ventricular volumes, mean blood pressure, and EF remained unchanged. A 27% reduction of elastance was observed (KLV, 0.111 ± 0.044 from 0.195 ± 0.089 mm Hg/mL; P <.01), whose magnitude was related to changes in BNP (P <.05) and to KLV at baseline (P <.01). No changes in KLV were observed in controls after 3 months (0.192 ± 0.115 from 0.195 ± 0.121 mm Hg/mL). Conclusions: In heart failure, left ventricular diastolic stiffness is related to neurohormonal derangement and is modified by physical training. This improvement in LV compliance could result from a combination of hemodynamic improvement and regression of the fibrotic process.

Original languageEnglish
Pages (from-to)327-333
Number of pages7
JournalJournal of Cardiac Failure
Volume15
Issue number4
DOIs
Publication statusPublished - May 2009

Keywords

  • diastolic operating stiffness
  • Heart failure
  • neurohormonal control
  • physical training

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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