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

Abstract

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 modifi cation (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 defi ned as successful LSM (group A = 23 patients), while a weight reduction < 2% was classifi ed 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 μg/ml, P< 0.01) were higher in group A than in group B. After 3 months of LSM, CPET showed a signifi cant improvement of VO2 peak ( P <0.01), EqCO2 ( P <0.01), O2-pulse ( P =0.02) and VE / VCO2 slope ( P =0.01) in group A. After one year of follow-up a modest but signifi cant reduction of left atrial size and mitral fl ow to mitral annulus velocity ratio E/E´ was seen in group A. LSM resulted in signifi cant improvement of NYHA status ( P =0.03) and higher freedom of rehospitalization ( P =0.04) in group A.Conclusion Successful lifestyle modifi cation 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.