Einfluss von körperlichem Training auf natriuretische Peptide, Adrenomedullin und Endothelin sowie auf Parameter der Belastbarkeit und der kardialen Funktion bei Patienten mit diastolischer Herzinsuffizienz

Effects of exercise training on natriuretic peptides, Adrenomedullin and Endothelin, exercise capacity and cardiac function in patients with diastolic heart failure

by Tinka Rutscher
Doctoral thesis
Date of Examination:2015-06-03
Date of issue:2015-06-03
Advisor:PD Dr. Frank Edelmann
Referee:PD Dr. Frank Edelmann
Referee:Prof. Dr. Michael Koziolek
Persistent Address: http://dx.doi.org/10.53846/goediss-5104

 

 

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Abstract

English

Background: Diastolic heart failure is a disease with growing clinical importance because of increasing prevalence and high mortality and morbidity. Treatment outcome on exercise capacity and cardiac function are still lacking. We wanted to prove the effect of structured exercise training (ET) on the natriuretic peptides, Adrenomedullin and Endothelin as soon as on exercise capacity and cardiac function in patients with diastolic heart failure/heart failure with preserved ejection function (HFpEF). Methods: A total of 64 patients (age 65±7 years, 56% female) with HFpEF were prospectively randomized (2:1) to supervised endurance/resistance training in addition to usual care (UC, n=20); (ET, n=44) over 3 months. Primary endpoint was the change in peak VO2; secondary endpoints included effects on neurohumoral activation (NA) and diastolic function. Results: peak VO2 increased (16.1±4.9 ml/min/kg to 18.7±5.4 ml/min/kg; p<0.001) with ET and remained unchanged (16.7±4.7 ml/min/kg to 16.0±6.0 ml/min/kg; p=ns) with UC. The mean benefit of ET was 3.3 ml/min/kg (95% confidence interval CI: 1.8 to 4.8; p<0.001). E/e´(mean difference of changes: -3.2, 95% CI:-4.3 to -2.1; p<0.001) and left atrial volume index decreased with ET and remained unchanged with UC (-4.0, 95% CI: -5.9 to -2.2; p<0.001). Natriuretic peptides, Adrenomedullin and Endothelin remained unchanged with ET and UC. Conclusions: We showed an specific collective of patients with limited capacity, determined diastolic function and significant moderate increasing neurohormones. There is an significant correlation between NA and exercise capacity. There is a moderat correlation between NA and diastolic function. Parameters of NA in process do not show directly the development in exercise capacitx and development in diastolic heart failure. They cannot be use as exclusive indicator fort the treatment outcome.
Keywords: diastolic heart failure; exercise training; natriuretic peptides; diastolic function
Schlagwörter: diastolische Herzinsuffizienz; körperliches Training; neurohumorale Aktivierung; diastolische Funktion
 
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