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Canadian Journal of Cardiology

Right Ventricular Function and Beneficial Effects of Cardiac Rehabilitation in Patients With Systolic Chronic Heart Failure

      Abstract

      Background

      It has been recognized that a comprehensive cardiac rehabilitation (CR) program improves mortality in patients with chronic heart failure. On the other hand, the magnitude of the improvement in exercise capacity after CR differs among individuals. The aim of this study was to assess the echocardiographic determinants of responders to CR using preload stress echocardiography.

      Methods

      We prospectively enrolled 58 chronic heart failure patients with reduced left ventricular ejection fraction (aged 62 ± 11 years; 69% male; left ventricular ejection fraction 43% ± 7%) who had received optimized medical treatment in a CR program for 5 months. We performed preload echocardiographic studies using leg positive pressure (LPP) to assess the echocardiographic parameters during preload augmentation. We defined 41 patients as a development cohort to assess the predictive value of echocardiographic variables. Next, we validated results in the remaining 17 patients as a validation cohort.

      Results

      In the development cohort, significant improvement in peak oxygen uptake (VO2) (>10%) after CR was observed in 58% patients. In a multivariable logistic regression model, the significant predictor of improvement in exercise capacity was right ventricular (RV) strain during LPP (odds ratio: 3.96 per 1 standard deviation; P = 0.01). An RV strain value of −16% during LPP had a good sensitivity of 0.79 and a specificity of 0.71 to identify patients with improvement in peak VO2. In the validation cohort, an optimal cutoff value of RV strain value was the same (area under the curve: 0.77, sensitivity: 0.78, specificity: 0.65).

      Conclusions

      RV strain during LPP may be an echocardiographic parameter for assessing beneficial effects of CR.

      Résumé

      Contexte

      Il est maintenant reconnu qu’un programme exhaustif de réadaptation cardiaque (RC) abaisse la mortalité des patients atteints d’insuffisance cardiaque chronique. Le degré d’amélioration de la capacité d’exercice physique obtenue grâce à la RC varie cependant d’une personne à l’autre. La présente étude avait pour but d’évaluer les déterminants échocardiographiques des répondeurs à la RC à l’aide d’une échocardiographie d’effort de précharge.

      Méthodes

      Nous avons procédé au recrutement prospectif de 58 patients atteints d’insuffisance cardiaque chronique présentant une fraction d’éjection ventriculaire gauche réduite (âge de 62 ± 11 ans; 69 % d’hommes; fraction d’éjection ventriculaire gauche 43 % ± 7 %) qui avaient reçu un traitement médical optimisé pendant 5 mois dans le cadre d’un programme de RC. Nous avons effectué des études électrocardiographiques de précharge en utilisant la méthode de pression positive des jambes (PPJ) pour évaluer les paramètres échocardiographiques pendant l’augmentation de la précharge. Nous avons formé une cohorte de développement constituée de 41 patients pour évaluer la valeur prédictive des variables échocardiographiques. Ensuite, nous avons validé les résultats obtenus dans la cohorte de validation constituée des 17 autres patients.

      Résultats

      Dans la cohorte de développement, une amélioration significative de la consommation d’oxygène (volume d’oxygène; VO2) maximale (> 10 %) après la RC a été observée chez 58 % des patients. Dans un modèle de régression logistique à variables multiples, le facteur prédictif significatif de la capacité d’exercice physique était la déformation du ventricule droit (VD) pendant le test de PPJ (rapport des cotes : 3,96 pour chaque écart-type; p = 0,01). Une déformation du VD de −16 % durant le test de PPJ avait une bonne sensibilité de 0,79 et une spécificité de 0,71 pour détecter les patients présentant une amélioration du VO2 maximal. Dans la cohorte de validation, la valeur seuil optimale de la déformation du VD était la même (aire sous la courbe : 0,77, sensibilité : 0,78, spécificité : 0,65).

      Conclusion

      La déformation du VD durant le test de PPJ pourrait être un paramètre échocardiographique utile pour évaluer les effets bénéfiques de la RC.
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