Changes in Ventricular Function After Vigorous Aerobic Exercise Training in Women with Pulmonary Arterial Hypertension

Abstract

PURPOSE: To determine if 10 weeks of vigorous aerobic exercise training (AET) worsens left ventricular diastolic and systolic function in a group of women with pulmonary arterial hypertension (PAH). METHODS: 18 women with PAH (age 56.2 ± 8.8 years, BMI 28.8 ± 7.3 kg/m2) underwent 10 weeks of vigorous AET at 70-80% heart rate reserve. Indices of cardiac function were measured during a graded exercise test (GXT) to peak exhaustion using bioelectrical impedance cardiography (ZCG) before and after the AET. A small subset (N=7) participated in a 10-week waiting period prior to beginning the AET and performed an additional GXT with ZCG before that period. A cohort of sedentary women serving as healthy controls (N=19) also performed a GXT with ZCG and were used for comparison. RESULTS: Left ventricular ejection fraction (EF; 48 ± 9.2 vs. 61.5 ± 13.3 %, p=0.034) and the systemic vascular resistance index (SVRI; 2,258 ± 419.1 vs. 2,939 ± 962.4 dyn·s/cm5·m2, p=0.008) were significantly lower in the baseline PAH group vs. healthy groups respectively at supine rest. At peak exercise, heart rate (HR) was lower in the PAH group vs. healthy control group (140 ± 13.3 vs. 170 ± 13.8 bpm, p<0.001) and SVRI higher in the PAH group (828 ± 141.1 vs. 824 ± 300.9 dyn·s/cm5·m2, p=0.050) when controlling for age and HR. After AET, the PAH group did not have a significant decline in left ventricular function, but rather a decrease in SVRI (828 ± 141.1 vs. 766 ± 139.6 dyn·s/cm5·m2, p=0.020) at peak exercise. The subset of subjects with PAH who participated in the 10-week waiting period had a significant decline in the early diastolic left ventricular filling ratio (EDFR; 95.9±19.4 vs. 76.2±18.9%, p=0.043) prior to AET. The EDFR remained unchanged after the AET training period in all subjects. CONCLUSIONS: Vigorous AET does not appear to be associated with significant declines in either left ventricular systolic or diastolic function in women with PAH. AET may be beneficial for reducing afterload and may be protective against decline in left ventricular diastolic function occurring over time. Funding Source: NIH/IRP 1 Z01 CL060068-02 CC.