Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial.
BACKGROUND
The effects of exercise training (ET) on left ventricular (LV) remodeling in chronic heart failure are not definitively established, and the safety of ET in these patients is still debated.


RESULTS
This multicenter study investigated the long-term effect of moderate ET on LV remodeling, work capacity, and quality of life (QoL) in 90 patients with stable chronic heart failure caused by LV systolic dysfunction, randomized to a 6-month ET program (T, n=45) or a control group (C, n=45). All patients underwent resting echocardiography, a cardiopulmonary exercise test, 6-minute walking test, and QoL assessment at entry and after 6 months. At entry, end-diastolic (EDV) and end-systolic (ESV) volume, ejection fraction, work capacity, peak o2, and walking distance were similar in the 2 groups. After 6 months, LV volumes diminished in T (EDV, from 142+/-26 to 135+/-26 mL/m2, P<0.006; ESV, from 107+/-24 to 97+/-24 mL/m2, P<0.05) but increased in C (EDV, from 147+/-41 to 156+/-42 mL/m2, P<0.01; ESV, from 110+/-34 to 118+/-34 mL/m2, P<0.01). Ejection fraction improved in T (P<0.001) but was unchanged in C (P=NS). Significant improvement in work capacity (P<0.001), peak VO2 (P<0.006), walking distance (P<0.001), and QoL (P<0.01) was observed in T but not in C (P=NS). T showed a trend toward fewer (P=0.05) hospital readmissions for worsening dyspnea in the absence of other adverse cardiac events.


CONCLUSIONS
In stable chronic heart failure, long-term moderate ET has no detrimental effect on LV volumes and function; rather, it attenuates abnormal remodeling. Furthermore, ET is safe and effective in improving exercise tolerance and QoL.
Giannuzzi
Pantaleo
P
Fondazione Salvatore Maugeri, IRCCS, Via Revislate, 13, 28013 Veruno, Italy. pgiannuzzi@fsm.it
Temporelli
Pier Luigi
PL
Corrà
Ugo
U
Tavazzi
Luigi
L
D002306:Cardiac Volume; D002908:Chronic Disease; D015331:Cohort Studies; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D004452:Echocardiography; D005081:Exercise Therapy; D017079:Exercise Tolerance; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006334:Heart Function Tests; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data; D011788:Quality of Life; D013995:Time; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D020257:Ventricular Remodeling