Lack of Benefits of Endurance Training in Patients with Chronic Heart Failure: Role of Asymptomatic Peripheral Artery Disease

Giuseppe Caminiti Maurizio Volterrani

doi:10.4172/2329-9096.1000156

Abstract

Purpose: To evaluate the impact of asymptomatic peripheral artery disease (PAD) on exercise recovery in patients with heart failure (HF). Methods: The study enrolled 204 HF patients in stable conditions, mean age 72 ± 12 years, M/F 138/66, consecutively admitted to our cardiac rehabilitation unit. Asymptomatic PAD was assessed by ankle/brachial index (ABI). Subjects with history of symptomatic PAD were excluded from the study. Exercise tolerance was evaluated by six minute walking test (6mwt). At admission patients were divided into three group according to their ABI index (ABI >0.9; ABI 0.6-0.9; ABI 0.9 (41.9%). In a multivariate logistic regression model, including several covariates, asymptomatic PAD predicted a reduced performance at 6MWT in the overall population (adjusted OR 1.82; 95% CI 1.66-2.11; p=0.03). Conclusions: Asymptomatic PAD is a marker of advanced HF and reduced physical performance. HF patients with asymptomatic PAD have lower functional recovery than subjects without asymptomatic PAD after exercise training. Asymptomatic PAD seems to be related to lack of benefit of exercise training in HF patients and a marker of frailty of these patients.

Highlights

Exercise training has been established as an adjuvant therapy in patients with heart failure (HF) due its broad spectrum of effects including improvement of exercise tolerance, quality of life and survival [1,2]
The presence of asymptomatic Peripheral arterial disease (PAD) can be readily identified by the ankle-brachial index (ABI), a simple test comparing systolic blood pressure measured in the arm and in the ankle by Doppler [11]
The independent prediction power of asymptomatic PAD on exercise recovery was evaluated through a logistic regression analysis in which we included as covariates some confounding variables such as age, diabetes, atrial fibrillation, and gender and ejection fraction

Summary

Introduction

Exercise training has been established as an adjuvant therapy in patients with heart failure (HF) due its broad spectrum of effects including improvement of exercise tolerance, quality of life and survival [1,2]. Some HF patients show limited improvement in exercise capacity after performing exercise training programs. This is an important point because lack of benefit to exercise training seems to be related to a poorer clinical outcome [3]. The association of PAD with lower exercise capacity and lack of benefit to exercise training in HF subjects has been recently demonstrated in retrospective studies [6,7]. Studies have demonstrated that PAD confers a markedly heightened risk of cardiovascular morbidity and mortality irrespective of the presence of claudication. It is possible that PAD affects exercise tolerance in HF subjects beyond the presence of exertional pain

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Discussion

Conclusion