Effects of cardiac rehabilitation on cardiopulmonary test parameters in heart failure: A real world experience

Giovanni Baccanelli; Michele Tomaselli; Umberto Ferri; Alessia Giglio; Carlotta Munforti; Gianfranco Parati; Mario Facchini; Lia Crotti; Gabriella Malfatto

doi:10.1016/j.ijcrp.2023.200178

Effects of cardiac rehabilitation on cardiopulmonary test parameters in heart failure: A real world experience

Int J Cardiol Cardiovasc Risk Prev. 2023 Feb 21:17:200178. doi: 10.1016/j.ijcrp.2023.200178. eCollection 2023 Jun.

Authors

Giovanni Baccanelli^{1

2}, Michele Tomaselli^{1

3}, Umberto Ferri^{1

2}, Alessia Giglio¹, Carlotta Munforti¹, Gianfranco Parati^{1

3}, Mario Facchini¹, Lia Crotti^{1

3}, Gabriella Malfatto¹

Affiliations

¹ Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche, Metaboliche, UO di Riabilitazione cardiologica, Ospedale S. Luca, Milano, Italy.
² Scuola di Specializzazione in Medicina dello sport e dell'esercizio fisico, Università di Milano-Bicocca, Milano, Italy.
³ Dipartimento di Medicina e Chirurgia, Università di Milano-Bicocca, Milano, Italy.

Abstract

Background: Cardio-Pulmonary Exercise Test (CPET) is the gold standard for evaluation of patients with heart failure (HF); however, its use is limited in everyday practice. We analyzed the use of CPET for HF management in the real world.

Methods: From 2009 to 2022, 341 patients with HF underwent 12-16 weeks of rehabilitation in our Centre. We present data from 203 patients (60%), excluding those unable to perform CPET, those with anaemia and severe pulmonary disease. Before and after rehabilitation, we performed CPET, blood tests and echocardiography, tailoring individual physical training to the results of baseline test. The following variables were considered: peak Respiratory Equivalent Ratio (RER), peakVO₂ (ml/Kg/min), VO₂ at aerobic threshold (VO₂AT,% maximal), VE/VCO₂ slope, P_(ET)CO₂, VO₂ /Work ratio (ΔVO₂/ΔWork).

Results: Rehabilitation improved peak VO₂, pulse O₂, VO₂ AT and ΔVO₂/ΔWork in all patients by about 13% (p < 0.01). Most patients (126, 62%) showed a reduced left ventricular ejection fraction (HFrEF), but rehabilitation was effective also in patients with mildly reduced (HFmrEF: n = 55, 27%) or preserved ejection fraction (HFpEF: n = 22, 11%).

Conclusions: Rehabilitation in patients with heart failure induces a significant recovery of cardiorespiratory performance easily assessed by CPET, that is applicable to the majority of them and should be used routinely in the programming and evaluating of cardiac rehabilitation programs.

Keywords: Cardiac rehabilitation; Cardiopulmonary exercise test; Heart failure.