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. 2023 Jan;28(1):193-206.
doi: 10.1007/s10741-022-10259-1. Epub 2022 Jul 13.

The effect of exercise training and physiotherapy on left and right heart function in heart failure with preserved ejection fraction: a systematic literature review

Eglė Palevičiūtė  1 , Toma Šimbelytė  2 , Christina A Eichstaedt  3   4 , Nicola Benjamin  3 , Benjamin Egenlauf  3 , Ekkehard Grünig  3 , Jelena Čelutkienė  2
Affiliations

The effect of exercise training and physiotherapy on left and right heart function in heart failure with preserved ejection fraction: a systematic literature review

Eglė Palevičiūtė et al. Heart Fail Rev. 2023 Jan.

Abstract

The impact of exercise training and physiotherapy on heart function and pulmonary circulation parameters in heart failure with preserved ejection fraction (HFpEF) patients is uncertain. Hence, we performed a systematic review of published trials studying physical training in HFpEF population, with a focus on exercise and physiotherapy effect on left ventricular (LV), right ventricular (RV) morphological, functional, and pulmonary circulation parameters. We searched Cochrane Library and MEDLINE/PubMed for trials that evaluated the effect of exercise training and/or physiotherapy in adult HFpEF patients (defined as LVEF ≥ 45%), including publications until March 2021. Our systematic review identified eighteen articles (n = 418 trained subjects, 4 to 52 weeks of training) and covered heterogeneous trials with various populations, designs, methodologies, and interventions. Five of twelve trials revealed a significant reduction of mitral E/e' ratio after the training (- 1.2 to - 4.9). Seven studies examined left atrial volume index; three of them showed its decrease (- 3.7 to - 8 ml/m2). Findings were inconsistent regarding improvement of cardiac output, E/A ratio, and E wave DecT and uncertain for RV function and pulmonary hypertension parameters. For now, no reliable evidence about rehabilitation effect on HFpEF cardiac mechanisms is available. There are some hypotheses generating findings on potential positive effects to parameters of LV filling pressure (E/e'), left atrium size, cardiac output, and RV function. This encourages a broader and more complex assessment of parameters reflecting cardiac function in future HFpEF exercise training studies.

Keywords: Cardiac imaging; Diastolic function; Exercise training; Heart failure with preserved ejection fraction; Physiotherapy.

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Conflict of interest statement

The author E.P. reports speaker honoraria fees from Johnson and Johnson and Medis Pharma outside this work. The authors T.Š., C.A.E, N.B., and B.E. have no competing interests to declare. The author E.G. reports research grants and speaker honoraria/consultancy fees from Actelion, Janssen, Bayer, MSD, Merck, and Ferrer and research grants to the institution from Acceleron, Actelion, Bayer, MSD, Janssen, Liquidia, United Therapeutics, and OMT outside the submitted work. The author J.Č. reports personal fees from AstraZeneca, Boehringer Ingelheim, Pfizer, Bayer, and Novartis outside this work.

Figures

Fig. 1
Fig. 1
Study flow diagram. This flow diagram shows the selection process of eligible studies
See this image and copyright information in PMC

References

    1. Reddy YNV, Borlaug BA. Heart failure with preserved ejection fraction. Curr Probl Cardiol. 2016;41:145–188. doi: 10.1016/j.cpcardiol.2015.12.002. - DOI - PubMed
    1. Lam CSP, Roger VL, Rodeheffer RJ, et al. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009;53:1119–1126. doi: 10.1016/j.jacc.2008.11.051. - DOI - PMC - PubMed
    1. Opitz CF, Hoeper MM, Gibbs JSR, et al. Pre-capillary, combined, and post-capillary pulmonary hypertension: a pathophysiological continuum. J Am Coll Cardiol. 2016;68:368–378. doi: 10.1016/j.jacc.2016.05.047. - DOI - PubMed
    1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–3726. doi: 10.1093/eurheartj/ehab368. - DOI - PubMed
    1. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021;42:17–96. doi: 10.1093/eurheartj/ehaa605. - DOI - PubMed

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