The Improvement of Left Atrial Function after Twelve Weeks of Supervised Concurrent Training in Patients with Heart Failure with Mid-Range Ejection Fraction: A Pilot Study

Abstract

Left atrial dysfunction is associated with exercise intolerance and poor prognosis in heart failure (HF). The effects of exercise training on atrial function in patients with HF with mid-range ejection fraction (HFmrEF) are unknown. The purpose of the present study was to assess the effects of a supervised concurrent training (SCT) program, lasting 12 weeks, on left atrial function of patients with HFmrEF. The study included 70 stable patients, who were randomly assigned into two groups: SCT with (three sessions/week) or a control (CON) group directed to follow contemporary exercise preventive guidelines at home. Before starting the training program and at 12 weeks, all patients performed an ergometric test, a 6 min walk test, and echocardiography. Between-group comparisons were made by analysis of variance (ANOVA). At 12 weeks, the duration of the ergometric test and distance walked at 6 min walk test presented a significant greater increase in SCT compared to the control (between-group p 0.0001 and p 0.004 respectively). Peak atrial longitudinal strain and conduit strain presented an increase of 29% and 34%, respectively, in the SCT, and were unchanged in CON (between-group p 0.008 and p 0.001, respectively). Peak atrial contraction strain increased by 21% in SCT, with no changes in CON (between-group p 0.002). Left ventricular global longitudinal strain increased significantly in SCT compared to control (between-groups p 0.03). In conclusions, SCT improved left atrial and left ventricular function in HFmrEF. Further studies are needed in order to verify whether these favourable effects of SCT on LA function are sustained and whether they will translate into clinical benefits for patients with HFmrEF.

Changes in left atrial function following two regimens of combined exercise training in patients with ischemic cardiomyopathy: a pilot study

“…The effects of other exercise modalities on the LA parameters should also be tested in future research. In this study, we found that the values of PALS were lower in comparison with those reported by the literature in healthy age-matched subjects and were instead comparable with those that we and other authors observed in HFmrEF ( 24 , 40 ). Conversely, the E/E′ ratio was in the normal range and remained unchanged after the CT program.…”

“…Preliminary data suggest the possibility of counteracting LA remodeling through exercise training. In a recent research, a regimen of CT, consisting of three sessions/week and lasting 12 weeks, was effective in increasing the reservoir strain and the contraction strain in patients with HFmrEF and underlying ICM ( 24 ). The present study confirms the results of the previous research and extends them to patients who are in a less advanced stage of ICM: indeed, in this study we enrolled asymptomatic subjects with normal LA volume, normal E/E′ ratio, with on average normal EF, who had never experienced symptoms or signs of HF.…”

“…Although exercise training is an accepted strategy for attenuating LV remodeling in ICM ( 22 , 23 ), less attention has been given to the LA. Improvement of the LA reservoir and contraction strains has recently been observed in patients with HF and mildly reduced EF (HFmrEF) after 12 weeks of CT ( 24 ). However, it remains to be established whether or not CT has beneficial effects on the LA function in patients with asymptomatic ICM which has not yet developed HF.…”