title: Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular-Arterial Coupling in Patients With Systolic Heart Failure.
abstract: BACKGROUND
  Success of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular-arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX-derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.
  
  
  RESULTS
  Thirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise-based CR. Noninvasive LV pressure-volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO2 was not in a significant correlation with the change in VAC (r=-0.18; P=0.31), mechanical efficiency (r=-0.16, P=0.39), or the change in ejection fraction (r=-0.07; P=0.68).
  
  
  CONCLUSIONS
  CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX-derived data in predicting clinical outcomes.
authors.affiliation: Department of Cardiology, Department of Cardiology, Yeditepe University Hospital, Ataşehir, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (E.A., B.A., N.B.).
authors.forename: Emre
authors.initials: E
authors.lastname: Aslanger
authors.affiliation: Department of Cardiology, Department of Cardiology, Yeditepe University Hospital, Ataşehir, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (E.A., B.A., N.B.).
authors.forename: Benjamin
authors.initials: B
authors.lastname: Assous
authors.affiliation: Department of Cardiology, Department of Cardiology, Yeditepe University Hospital, Ataşehir, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (E.A., B.A., N.B.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bihry
authors.affiliation: Lariboisière Hospital, Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), UMR-S 942, Université Paris Diderot, DHU FIRE, Paris, France (F.B., D.L., A.C.S.).
authors.forename: Florence
authors.initials: F
authors.lastname: Beauvais
authors.affiliation: Lariboisière Hospital, Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), UMR-S 942, Université Paris Diderot, DHU FIRE, Paris, France (F.B., D.L., A.C.S.).
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.affiliation: Lariboisière Hospital, Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), UMR-S 942, Université Paris Diderot, DHU FIRE, Paris, France (F.B., D.L., A.C.S.).
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D062186:Arterial Pressure; D001642:Bicycling; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006173:Gymnastics; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010101:Oxygen Consumption; D010297:Paris; D063177:Pulse Wave Analysis; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020127:Recovery of Function; D055070:Resistance Training; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D059289:Vascular Stiffness; D016277:Ventricular Function, Left; D017725:Ventricular Pressure; D014891:Weight Lifting
keywords: cardiopulmonary exercise test; exercise training; ventricular function; ventricular‐arterial coupling