open access

Vol 69, No 4 (2011)
Original articles
Published online: 2011-04-26
Submitted: 2012-12-28
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The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with heart failure

Grzegorz Gielerak, Ewa Piotrowicz, Paweł Krzesiński, Jarosław Kowal, Monika Grzęda, Ryszard Piotrowicz
Kardiol Pol 2011;69(4):309-317.

open access

Vol 69, No 4 (2011)
Original articles
Published online: 2011-04-26
Submitted: 2012-12-28

Abstract


Background: Cardiac rehabilitation (CR) is an important element of heart failure (HF) treatment although the mechanisms of its beneficial effects remain debatable.
Aim: To evaluate the haemodynamic effects of CR measured by impedance cardiography in patients with HF.
Methods: Study group included 50 HF patients (aged 56.2 ± 8.8 years, NYHA class II and III, left ventricular ejection fraction ≤ 40%) who underwent 8-week CR. Clinical and haemodynamic assessment was performed before and after CR.
Results: As a result of CR, exercise tolerance improved significantly as measured by peakVO2 (18.7 ± 4.4 vs 20.8 ± 4.7 mL/kg/min; p = 0.025), six-minute walking test distance (6-MWT; 417.8 ± 103.6 vs 467.7 ± 98.4 m, p = 0.016) and NYHA class (change to the lower NYHA class in 30% of subjects). A significant reduction of the left atrial diameter was observed in echocardiography (4.55 ± 0.63 vs 4.43 ± 0.59 cm, p = 0.017). Impedance cardiography revealed a significant change in diastolic to systolic wave ratio (O/C ratio; 54.8 ± 24.0 vs 47.9 ± 20.8%, p = 0.021). A significant change in the haemodynamic profile of the left ventricular blood ejection was also observed. Before CR, transthoracic fluid content (TFC) correlated with stroke index (SI; R = 0.37, p < 0.01), compared to no correlation after CR (R = 0.00, NS). Reduction in TFC correlated with prolongation of the 6-MWT (R = -0.32, p = 0.06), and increase in systolic time ratio (STR) correlated with increase in peakVOM2 (R = 0.40, p = 0.006). Subjects who benefited from CR tended to have lower heart rate (61.4 ± 9.0 vs 67.7 ± 10.7 1/min, p = 0.07), longer pre-ejection period (PEP; 12.2 ± 11.6 ms vs -2.6 ± 23.1 ms, p = 0.018) and non-significantly higher STR (0.423 ± 0.123 vs 0.377 ± 0.102, p = 0.37).
Conclusions: Impedance cardiography revealed beneficial effects of CR, manifested by reduced fluid retention and a reduced effect of preload on left ventricular relaxation and ejection.
Kardiol Pol 2011; 69, 4: 309-317

Abstract


Background: Cardiac rehabilitation (CR) is an important element of heart failure (HF) treatment although the mechanisms of its beneficial effects remain debatable.
Aim: To evaluate the haemodynamic effects of CR measured by impedance cardiography in patients with HF.
Methods: Study group included 50 HF patients (aged 56.2 ± 8.8 years, NYHA class II and III, left ventricular ejection fraction ≤ 40%) who underwent 8-week CR. Clinical and haemodynamic assessment was performed before and after CR.
Results: As a result of CR, exercise tolerance improved significantly as measured by peakVO2 (18.7 ± 4.4 vs 20.8 ± 4.7 mL/kg/min; p = 0.025), six-minute walking test distance (6-MWT; 417.8 ± 103.6 vs 467.7 ± 98.4 m, p = 0.016) and NYHA class (change to the lower NYHA class in 30% of subjects). A significant reduction of the left atrial diameter was observed in echocardiography (4.55 ± 0.63 vs 4.43 ± 0.59 cm, p = 0.017). Impedance cardiography revealed a significant change in diastolic to systolic wave ratio (O/C ratio; 54.8 ± 24.0 vs 47.9 ± 20.8%, p = 0.021). A significant change in the haemodynamic profile of the left ventricular blood ejection was also observed. Before CR, transthoracic fluid content (TFC) correlated with stroke index (SI; R = 0.37, p < 0.01), compared to no correlation after CR (R = 0.00, NS). Reduction in TFC correlated with prolongation of the 6-MWT (R = -0.32, p = 0.06), and increase in systolic time ratio (STR) correlated with increase in peakVOM2 (R = 0.40, p = 0.006). Subjects who benefited from CR tended to have lower heart rate (61.4 ± 9.0 vs 67.7 ± 10.7 1/min, p = 0.07), longer pre-ejection period (PEP; 12.2 ± 11.6 ms vs -2.6 ± 23.1 ms, p = 0.018) and non-significantly higher STR (0.423 ± 0.123 vs 0.377 ± 0.102, p = 0.37).
Conclusions: Impedance cardiography revealed beneficial effects of CR, manifested by reduced fluid retention and a reduced effect of preload on left ventricular relaxation and ejection.
Kardiol Pol 2011; 69, 4: 309-317
Get Citation

Keywords

heart failure; cardiac rehabilitation; impedance cardiography

About this article
Title

The effects of cardiac rehabilitation on haemodynamic parameters measured by impedance cardiography in patients with heart failure

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 69, No 4 (2011)

Pages

309-317

Published online

2011-04-26

Bibliographic record

Kardiol Pol 2011;69(4):309-317.

Keywords

heart failure
cardiac rehabilitation
impedance cardiography

Authors

Grzegorz Gielerak
Ewa Piotrowicz
Paweł Krzesiński
Jarosław Kowal
Monika Grzęda
Ryszard Piotrowicz

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