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  • 1
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    Online Resource
    Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction
    Wiley ; 2018
    In:  ESC Heart Failure Vol. 5, No. 1 ( 2018-02), p. 53-62
    Details
    In: ESC Heart Failure, Wiley, Vol. 5, No. 1 ( 2018-02), p. 53-62
    Abstract: Heart failure with preserved ejection fraction (HFpEF) remains a common condition with no pharmacological treatment. Physical activity (PA) improves symptoms and quality of life (QoL), but no clear recommendations exist on PA in HFpEF patients. We investigated the association of PA (amount/intensity) on clinical phenotype in HFpEF. Methods and results The Aldosterone in Diastolic Heart Failure trial investigated spironolactone vs. placebo in stable HFpEF patients. At baseline, all patients underwent detailed phenotypization including echocardiography, cardiopulmonary exercise testing, 6 minute walking test (6MWT), and QoL assessment (36‐item Short‐Form questionnaire). PA was assessed by a self‐report questionnaire, classified in metabolic equivalents of task (MET) and analysed with regard to exercise capacity, diastolic function, and QoL. Four hundred twenty‐two patients (52% women, age 67 ± 8 years, New York Heart Association II and III) were classified by weekly MET hours into a low ( 〈 70), middle (70–140), or high ( 〉 140) level of PA. Total PA correlated positively with 6MWT distance ( r  = 0.17; P  = 0.002) and physical function of QoL ( r  = 0.10; P  = 0.05), but not with peak oxygen uptake (peakVO 2 ). In contrast, both 6MWT distance and peakVO 2 were significantly higher in patients who performed high‐intensity PA for 〉 8 h/week ( P   〈  0.001, P  = 0.02, respectively). Time of high‐intensity PA was related to higher 6MWT distance ( r  = 0.21, P   〈  0.001), peakVO 2 , and better physical function of QoL (both r  = 0.13, P  = 0.01), whereas low‐intensity PA did not show significant associations. Interestingly, PA was not related to any measure of diastolic function. Conclusions A higher amount of PA is related to higher submaximal exercise capacity and physical function of QoL. Regarding maximal exercise capacity, only high‐intensity PA showed significant association in HFpEF patients.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v5.1
    DOI: 10.1002/ehf2.12227
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2814355-3
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  • 2
    Online Resource
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    Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
    Wiley ; 2019
    In:  ESC Heart Failure Vol. 6, No. 1 ( 2019-02), p. 146-153
    Details
    In: ESC Heart Failure, Wiley, Vol. 6, No. 1 ( 2019-02), p. 146-153
    Abstract: The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). Methods and results Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e′ at rest 9–14, and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) at rest  〈  220 pg/mL; n  = 13) and a control group constituted from asymptomatic patients with arterial hypertension ( n  = 19) and healthy subjects ( n  = 18) were included. All patients were analysed by two‐dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT‐proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO 2  ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e′ ratio  〉 15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e′ with tricuspid regurgitation (TR) velocity  〉  2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e′ was significantly linked to worse peak VO 2 , and the combination of an increase of both E/e′ and TR velocity was associated with elevated NT‐proBNP values during exercise. Conclusions The findings of this pilot study suggest that DST using E/e′ ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v6.1
    DOI: 10.1002/ehf2.12375
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2814355-3
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  • 3
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    Online Resource
    Exercise training in Diastolic Heart Failure (Ex‐ DHF ): rationale and design of a multicentre, prospective, randomized, controlled, parallel group trial
    Wiley ; 2017
    In:  European Journal of Heart Failure Vol. 19, No. 8 ( 2017-08), p. 1067-1074
    Details
    In: European Journal of Heart Failure, Wiley, Vol. 19, No. 8 ( 2017-08), p. 1067-1074
    Abstract: Heart failure with preserved ejection fraction ( HFpEF ) is a common disease with high incidence and increasing prevalence. Patients suffer from functional limitation, poor health‐related quality of life, and reduced prognosis. A pilot study in a smaller group of HFpEF patients showed that structured, supervised exercise training ( ET ) improves maximal exercise capacity, diastolic function, and physical quality of life. However, the long‐term effects of ET on patient‐related outcomes remain unclear in HFpEF . The primary objective of the Exercise training in Diastolic Heart Failure (Ex‐DHF) trial is to investigate whether a 12 month supervised ET can improve a clinically meaningful composite outcome score in HFpEF patients. Components of the outcome score are all‐cause mortality, hospitalizations, NYHA functional class, global self‐rated health, maximal exercise capacity, and diastolic function. After undergoing baseline assessments to determine whether ET can be performed safely, 320 patients at 11 trial sites with stable HFpEF are randomized 1:1 to supervised ET in addition to usual care or to usual care alone. Patients randomized to ET perform supervised endurance/resistance ET (3 times/week at a certified training centre) for 12 months. At baseline and during follow‐up, anthropometry, echocardiography, cardiopulmonary exercise testing, and health‐related quality of life evaluation are performed. Blood samples are collected to examine various biomarkers. Overall physical activity, training sessions, and adherence are monitored and documented throughout the study using patient diaries, heart rate monitors, and accelerometers. The Ex‐ DHF trial is the first multicentre trial to assess the long‐term effects of a supervised ET programme on different outcome measures in patients with HFpEF .
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    URL: Article
    DOI: 10.1002/ejhf.2017.19.issue-8
    DOI: 10.1002/ejhf.862
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1500332-2
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  • 4
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    Online Resource
    Investigating a biomarker‐driven approach to target collagen turnover in diabetic heart failure with preserved ejection fraction patients. Effect of torasemide versus furosemide on serum C‐terminal propeptide of procollagen type I (DROP‐PIP trial)
    Wiley ; 2018
    In:  European Journal of Heart Failure Vol. 20, No. 3 ( 2018-03), p. 460-470
    Details
    In: European Journal of Heart Failure, Wiley, Vol. 20, No. 3 ( 2018-03), p. 460-470
    Abstract: Heart failure with preserved ejection fraction (HFpEF) is associated with myocardial remodelling including severe pro‐fibrotic changes contributing to an increase in left ventricular stiffness and diastolic dysfunction. Serum C‐terminal propeptide of procollagen type I (PIP) strongly correlates with the turnover of extracellular cardiac matrix proteins and fibrosis. Torasemide, but not furosemide, was described to reduce collagen type I synthesis in clinically unstable patients with heart failure with reduced ejection fraction. We evaluated whether its effect translated to HFpEF patients with type 2 diabetes mellitus (T2DM) and abnormal basal PIP levels. Methods and results We performed a relatively small, single‐centre, randomised, double‐blind, two‐arm parallel‐group, active controlled clinical trial in 35 HFpEF patients with T2DM to determine the effects of a 9‐month treatment with torasemide vs. furosemide on changes of serum PIP levels. Patients with increased PIP levels (≥110 ng/mL), or evidence of structural changes with a left atrial volume index (LAVI) 〉 29 mL/m 2 and abnormal PIP levels (≥70 ng/mL), were eligible to participate. Fifteen patients were female (42%), mean age was 69 years, body mass index was 34.7 kg/m 2 , 83% were in New York Heart Association class II/III. Echocardiographic characteristics showed a mean left ventricular ejection fraction of 〉 60%, a left ventricular mass index 〉 120 g/m 2 , an E/e' ratio of 14, and a LAVI of 40 mL/m 2 with a NT‐proBNP of 174 ng/L and a 6‐minute walk distance of 421 m. Mean per cent change in PIP was 2.63 ± 5.68% (±SEM) in torasemide vs. 2.74 ± 6.49% in furosemide ( P = 0.9898) treated patients. Torasemide was not superior to furosemide in improving functional capacity, diastolic function, quality of life, or neuroendocrine activation. Conclusion In this hypothesis‐generating, mechanistic trial in stable HFpEF patients with T2DM, neither long‐term administration of torasemide nor furosemide was associated with a significant effect on myocardial fibrosis, as assessed by serum PIP. Further studies are urgently needed in this field. More specific diuretic and anti‐fibrotic treatment strategies in T2DM and/or HFpEF are warranted.
    Type of Medium: Online Resource
    ISSN: 1388-9842 , 1879-0844
    URL: Issue
    URL: Article
    DOI: 10.1002/ejhf.2018.20.issue-3
    DOI: 10.1002/ejhf.960
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 1500332-2
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