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Abstract
Title: |
Improvement
in Autonomic Dysfunction Manifested by Altered Heart Rate Variability,
T-Wave-Alternans and Norepinephrine by Long-Term Exercise in Chronic Heart
Failure |
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Presentation
Start: |
Tuesday,
Mar 09, 2004, 4:00 PM - 5:00 PM |
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Topic: |
Myocardial
Function/Heart Failure--Clinical |
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Author
Block: |
Robert
M. Nechwatal,
Michael Horn, Uwe Scharf, Bettina Mochalski, Ulrike Lachenmeyer, Christiaan
Barnard Klinik, Dahlen, Germany |
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Background:
In recent years exercise training has become an established therapy for
patients with stable chronic heart failure. However there is a paucity of
data on the effects of long term training on autonomic dysfunction. Methods:
100 patients with DCM and CHD were randomized to an exercise (n=50, mean
age:49,9+-9,3,mean ejection fraction (EF) 33,3+-5,7%)or to a control group
(n=50, mean age:54,7+-11,3,EF: 32,4+-5,3%).Patients underwent six 20 minute
supervised training sessions per week at a VO2 of 60% VO2peak. Before and
after the six month study period exercise testing with respiratory gas
exchange, heart rate variability in the time domain on holter monitoring,
norepinephrine plasma values and T-wave alternans testing were performed.
Results:See Table.VO2AT: oxygen uptake at the anaerobic threshold. *:
p<0,05 **: p<0,01 vs pre-training.id: indeterminate. 10 patients in the
exercise group and 2 in the control group did not complete the protocol: one
of each group died unassociated with exercise, one of each group developed
atrial fibrillation, one had a CABG and seven stopped for compliance reasons.
Conclusions: Long term training in stable heart failure is a safe means to
improve functional capacity and autonomic dysfunction. Mean heart rate,
norepinephrine and SDNN were improved significantly,the last even more
pronounced in the subgroup with SDNN<100. The conversion of a positive
TWA-test in 6 patients in the training group could used for therapeutic
intervention.
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