title: Age-related effects of exercise training on diastolic function in heart failure with reduced ejection fraction: the Leipzig Exercise Intervention in Chronic Heart Failure and Aging (LEICA) Diastolic Dysfunction Study.
abstract: OBJECTIVE
  Diastolic dysfunction (DD) was identified as a predictor of adverse prognosis in heart failure with reduced ejection fraction (HFREF). It is, however, unknown if DD is improved by exercise training, which is known to induce reverse remodelling, and if the training effect is attenuated in elderly HFREF patients. We therefore assessed DD in a cohort of referent controls (RCs) and HFREF patients and studied the response of DD to endurance exercise in two age groups (≤55 years and ≥65 years).
  
  
  RESULTS
  Sixty RC (30 ≤ 55 years, mean age 50 ± 5 years; 30 ≥ 65 years, 72 ± 4 years) and 60 HFREF patients (30 ≤ 55 years, 46 ± 5 years; 30 ≥ 65 years, 72 ± 5 years, EF 28 ± 5%) were randomized to 4 weeks of supervised endurance training or to a control group. Exercise training was effective in reducing LV isovolumetric relaxation time by 29% in young and by 26% in old HFREF patients (P< 0.05 for both). As assessed by tissue Doppler, septal E' increased by 37% in young and by 39% among old HFREF patients (P< 0.005 for both) resulting in a significant decrease in the E/E' ratio from 13 ± 1 to 10 ± 1 in young and 14 ± 1 to 11 ± 1 in old HFREF patients (P< 0.05 for both). Serum levels of N-terminal pro brain natriuretic peptide were significantly reduced after endurance training in HFREF patients of all ages.
  
  
  CONCLUSIONS
  In HFREF, diastolic function is significantly impaired in all age groups. Endurance training is highly effective in improving left ventricular diastolic function in HFREF patients regardless of age. This study is registered at ClinicalTrials.gov (number: NCT00176319).
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sandri
authors.forename: Irina
authors.initials: I
authors.lastname: Kozarez
authors.forename: Volker
authors.initials: V
authors.lastname: Adams
authors.forename: Norman
authors.initials: N
authors.lastname: Mangner
authors.forename: Robert
authors.initials: R
authors.lastname: Höllriegel
authors.forename: Sandra
authors.initials: S
authors.lastname: Erbs
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Sven
authors.initials: S
authors.lastname: Möbius-Winkler
authors.forename: Joachim
authors.initials: J
authors.lastname: Thiery
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kratzsch
authors.forename: Daniel
authors.initials: D
authors.lastname: Teupser
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Stephan
authors.initials: S
authors.lastname: Gielen
mesh_terms: D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D004562:Electrocardiography; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D054144:Heart Failure, Diastolic / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain