Moderate Heart Failure Patients Research Articles

Addition of non-invasive ventilatory support to combined aerobic and resistance training improves dyspnea and quality of life in heart failure patients: a randomized controlled trial

Objective: To test the hypothesis that combined aerobic and resistance training and non-invasive ventilatory support result in additional benefits compared with combined aerobic and resistance training alone in heart failure patients. Design: A randomized, single-blind, controlled study. Setting: Cardiac rehabilitation center. Participants: A total of 46 patients with New York Heart Association class II/III heart failure were randomly assigned to a 10-week program of combined aerobic and resistance training, plus non-invasive ventilatory support (n = 23) or combined aerobic and resistance training alone (n = 23). Methods: Before and after intervention, results for the following were obtained: 6-minute walk test, forced vital capacity, forced expiratory volume at one second, maximal inspiratory muscle pressure, and maximal expiratory muscle pressure, with evaluation of dyspnea by the London Chest Activity of Daily Living scale, and quality of life with the Minnesota Living With Heart Failure questionnaire. Results: Of the 46 included patients, 40 completed the protocol. The combined aerobic and resistance training plus non-invasive ventilatory support, as compared with combined aerobic and resistance training alone, resulted in significantly greater benefit for dyspnea (mean change: 4.8 vs. 1.3, p = 0.004), and quality of life (mean change: 19.3 vs. 6.8, p = 0.017). In both groups, the 6-minute walk test improved significantly (mean change: 45.7 vs. 44.1, p = 0.924), but without a statistically significant difference. Conclusion: Non-invasive ventilatory support combined with combined aerobic and resistance training provides additional benefits for dyspnea and quality of life in moderate heart failure patients. Trial registration: ClinicalTrials.gov identifier: NCT02384798. Registered 03 April 2015.

Circulating microRNA-150-5p as a novel biomarker for advanced heart failure: A genome-wide prospective study

Circulating microRNAs (miRs) are promising biomarkers for heart failure (HF). Previous studies have provided inconsistent miR "signatures." The phenotypic and pathophysiologic heterogeneity of HF may have contributed to this inconsistency. In this study we assessed whether advanced HF (AHF) patients present a distinct miR signature compared with healthy subjects (HS) and mild to moderate HF (MHF) patients. The study consisted of 2 phases: a screening phase and a validation phase. In the screening phase, 752 miRs were profiled in HS and MHF and AHF patients (N = 15), using the real-time quantitative polymerase chain reaction (RT-qPCR) technique and global mean normalization. In the validation phase, the miRs found to be significantly dysregulated in AHF patients compared with both HS and MHF patients were validated in 15 HS, 25 patients with MHF and 29 with AHF, using RT-qPCR, and normalizing to exogenous (cel-miR-39) and endogenous controls. In the screening phase, 5 miRs were found to be significantly dysregulated: -26a-5p; -145-3p; -150-5p; -485-3p; and -487b-3p. In the validation phase, miR-150-5p was confirmed to be significantly downregulated in AHF patients when compared with both HS and MHF patients, irrespective of the normalization method used. miR-26a-5p was confirmed to be significantly dysregulated only when normalized to cell-miR-39. Dysregulation of the other miRs could not be confirmed. miR-150-5p was significantly associated with maladaptive remodeling, disease severity and outcome. Our data suggest miR-150-5p as a novel circulating biomarker for AHF. The association of miR-150-5p with maladaptive remodeling, disease severity and outcome supports the pathophysiologic relevance of downregulated miR-150-5p expression to AHF.

Effects of exercise training on neurovascular control and skeletal myopathy in systolic heart failure.

Neurohormonal excitation and dyspnea are the hallmarks of heart failure (HF) and have long been associated with poor prognosis in HF patients. Sympathetic nerve activity (SNA) and ventilatory equivalent of carbon dioxide (VE/VO2) are elevated in moderate HF patients and increased even further in severe HF patients. The increase in SNA in HF patients is present regardless of age, sex, and etiology of systolic dysfunction. Neurohormonal activation is the major mediator of the peripheral vasoconstriction characteristic of HF patients. In addition, reduction in peripheral blood flow increases muscle inflammation, oxidative stress, and protein degradation, which is the essence of the skeletal myopathy and exercise intolerance in HF. Here we discuss the beneficial effects of exercise training on resting SNA in patients with systolic HF and its central and peripheral mechanisms of control. Furthermore, we discuss the exercise-mediated improvement in peripheral vasoconstriction in patients with HF. We will also focus on the effects of exercise training on ventilatory responses. Finally, we review the effects of exercise training on features of the skeletal myopathy in HF. In summary, exercise training plays an important role in HF, working synergistically with pharmacological therapies to ameliorate these abnormalities in clinical practice.

Novel approaches to heart rate modulation in chronic heart failure

Copyright © Polskie Towarzystwo Kardiologiczne INTRODUCTION The most recent version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) has introduced two important innovations for the medical treatment of chronic HF with reduced ejection fraction (EF): mineralo-corticoid receptor antagonists (MCRA) and the If channel blocker ivabradine have now a recognised indication in patients remaining symptomatic despite diuretics, angiotensin converting enzyme inhibitors (or angiotensin receptor blockers in case of intolerance) and beta-blockers [1]. Mineralo-corticoid receptor antagonists are recommended following the EMPHASIS trial which demonstrated the benefit of eplerenone on cardiovascular mortality or HF hospitalisations as well as on all causes mortality in mild to moderate HF patients with reduced EF [2]. According to the ESC Guidelines, ivabradine should be considered when patients remain symptomatic despite the addition of a MCRA and when they have an increased heart rate (HR) ≥ 70 bpm in the context of sinus rhythm. This new recommendation derives from the results of the large outcome trial using this new agent, the SHIFT trial (Systolic Heart Failure Treatment with the If inhibitor Ivabradine trial) [3].

11 Cause-of-death analysis in moderate heart failure patients with an implantable cardioverter defibrillator. Results of a multicentric French cohort study

11 Cause-of-death analysis in moderate heart failure patients with an implantable cardioverter defibrillator. Results of a multicentric French cohort study

AB19-3: Failure of spironolactone to reduce mortality or the need for an ICD in chronic moderate heart failure: Observations from the sudden cardiac death heart failure trial

Aldosterone blockade in severe heart failure (HF) and post-infarction HF reduces mortality and strongly reduces sudden cardiac death (SCD). Its benefit in chronic moderate HF and in those moderate HF patients with an implantable defibrillator (ICD) is unknown.

Assessment of tolerance of acute exercise and bicycle training in moderate heart failure patients with cardiac troponin I? Olaf Schulz, Ariane Kromer. Heinrich-Mann-Hospital for Cardiac Rehabilitation, Bad Liebenstein, Germany, Cooperative Interventional Cardiology Spandau, Berlin, Germany

Assessment of tolerance of acute exercise and bicycle training in moderate heart failure patients with cardiac troponin I? Olaf Schulz, Ariane Kromer. Heinrich-Mann-Hospital for Cardiac Rehabilitation, Bad Liebenstein, Germany, Cooperative Interventional Cardiology Spandau, Berlin, Germany

Additional effects of amlodipine for moderate heart failure patients with idiopathic dilated cardiomyopathy during beta-blocker therapy

Additional effects of amlodipine for moderate heart failure patients with idiopathic dilated cardiomyopathy during beta-blocker therapy