title: Cardiovascular effects of 1 year of progressive endurance exercise training in patients with heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Heart failure with preserved ejection fraction (HFpEF) is a disease of the elderly with cardiovascular stiffening and reduced exercise capacity. Exercise training appears to improve exercise capacity and cardiovascular function in heart failure with reduced ejection fraction. However, it is unclear whether exercise training could improve cardiovascular stiffness, exercise capacity, and ventricular-arterial coupling in HFpEF.
  
  
  METHODS
  Eleven HFpEF patients and 13 healthy controls underwent invasive measurements with right heart catheterization to define Starling and left ventricular (LV) pressure-volume curves; secondary functional outcomes included Doppler echocardiography, arterial stiffness, cardiopulmonary exercise testing with cardiac output measurement, and ventricular-arterial coupling assessed by the dynamic Starling mechanism. Seven of 11 HFpEF patients (74.9 ± 6 years; 3 men/4 women) completed 1 year of endurance training followed by repeat measurements. Pulmonary capillary wedge pressures and LV end-diastolic volumes were measured at baseline during decreased and increased cardiac filling. LV compliance was assessed by the slope of the pressure-volume curve. Beat-to-beat LV end-diastolic pressure (estimated from pulmonary arterial diastolic pressure) and stroke volume index were obtained, and spectral transfer function analysis was used to assess the dynamic Starling mechanism.
  
  
  RESULTS
  Before training, HFpEF patients had reduced exercise capacity, distensibility and dynamic Starling mechanism but similar LV compliance and end-diastolic volumes compared to controls albeit with elevated filling pressure and increased wall stress. One year of training had little effect on LV compliance and volumes, arterial stiffness, exercise capacity or ventricular-arterial coupling.
  
  
  CONCLUSIONS
  Contrary to our hypothesis, 1 year of endurance training failed to impart favorable effects on cardiovascular stiffness or function in HFpEF.
authors.affiliation: The University of Texas Southwestern Medical Center at Dallas, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujimoto
authors.forename: Anand
authors.initials: A
authors.lastname: Prasad
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.forename: Paul S
authors.initials: PS
authors.lastname: Bhella
authors.forename: Shigeki
authors.initials: S
authors.lastname: Shibata
authors.forename: Dean
authors.initials: D
authors.lastname: Palmer
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Levine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D059289:Vascular Stiffness; D016277:Ventricular Function, Left / Q000502:physiology