The Role In Passive Movement To Improve The Exercise Capacity Of Patients With Diastolic Heart Failure

Objectives : Heart failure with preserved ejection fraction(HFPEF) is a significant and costly health problem, no pharmacological therapy has shown to be effective in improving outcomes. Previous studies has indicated that exercise training can improved symptom and outcome in patients with heart failure with preserved ejection fraction, little is known the effect of passive exercise training. In this study,we sought to investigated the effect of passive leg movement(PLM) in improving quality of life and outcomes in HFPEF patients, and the role of endothelial dysfunction in exercise capacity of HFPEF.Background:Endothelial dysfunction plays an importance role in the initiation and progression of HFPEF, is a prediction of HFPEF and may take part in the pathogenesis of HFPEF. Passive exercise training has been proved to improve symptom in heart failure patients, while little is known in HFPEF.Methods:We enrolled NYHA II-IV in patients with HFPEF in second affiliated hospital of Nanchang University, from December 2013 to December 2014. Plasma N-terminal pro-B-type natriuretic peptide(NT-pro BNP), reactive hyperemia index(RHI), augmentation index, Minnesota Living with Heart Failure Questionnaire(MLHFQ), 6-min walk test and echocardiography were collected. Patients was randomly assigned to either PLM group(cycling 40/min 20min/day×3day) or attention control. Plasma NT-pro BNP, RHI, AI, MLHFQ, 6-min walk test and echocardiography were assessed at the end of test.Results : A total of 44 patients with HFPEF were included, comprising 20 training and 24 control group. Compared with control group, NT-pro BNP was decreased(700.70 ± 750.53vs312.50 ±364.49pg/ml,P=0.03), MLHFQ was improved(4.20±1.32vs8.42±2.95,P < 0.01), velocity of tricuspid regurgitation was decreased(57.82±36.48vs10.28±28.27cm/s, P < 0.01) and pulmonary artery pressure was decreased(10.07± 6.21vs1.67 ±5.17 mm Hg,P<0.01) in the PLM group. Meanwhile,RHI(0.11±0.46 vs-0.29±0.32, P < 0.01) and 6-min walk test(55.90±42.06vs18.42±24.86 m,P=0.001) were improved in the PLM group. There is a positive association between baseline RHI and baseline 6-min walk test(r = 0.345, p = 0.022),d-RHI and d-6-min walk test(r = 0.387, p = 0.01). There was a trended toward an improvement in hospital day between the two group without statistical significant.Conclusion:Passive leg movement can inprove cardiovascular function, exercise cap acity and quality of life in paitents with heart failure with pressurved ejection fraction,which is associated with a decreased of pulmany arterial pressure and an improveme nt of endothelial function.