Zusammenhang zwischen Ausmaß der körperlichen Betätigung im Alltag und Ausprägung der Leistungseinschränkung und Schwere der diastolischen Dysfunktion bei Patienten mit HFpEF
Relationship between the amount of everyday physical activity and the extent of physical limitation and degree of diastolic dysfunction in patients with HFpEF.
by Inke Bartels-Yevtushenko née Bartels
Date of Examination:2022-03-02
Date of issue:2022-02-14
Advisor:Prof. Dr. Frank Edelmann
Referee:PD Dr. Alexander Freiherr von Hammerstein-Equord
Referee:Prof. Dr. Margarete Schön
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EnglishHeart failure with preserved ejection fraction (HFpEF) is a rapidly progressing chronical heart disease with a bad clinical prognosis. Predominantly found in elderly female patients, HFpEF-patients suffer from a reduction in physical performance and quality of life (QoL) and ultimately face cardiopulmonary failure in the mid- or long-term. Assumed to be less relevant than heart failure with reduced ejection fraction (HFrEF) for a long time, recent studies found that HFpEF is likely to be the more prevalent form of heart failure. Unlike for HFrEF, there doesn’t exist any effective pharmacological therapy for HFpEF yet. However, several studies found an improvement of cardiorespiratory fitness (CRF) and QoL with specific aerobic exercise training (ET), whereas one study even found a reverse remodeling of pathological cardiac structure und diastolic function under a specific ET-regimen. Expanding on the topic of potential benefit for HFpEF-patients through ET, this study focuses on everyday physical activity (PA) in contrast to specific ET and its impact on CRF and QoL for HFpEF-patients. A total of 422 HFpEF-patients (age 67 ± 8 years, 52% Female) were surveyed regarding their self-estimated physical function as a dimension of QoL on one hand, and their level of weekly PA, measured in metabolic equivalent of task (MET), on the other. Furthermore, echocardiographic examination, spiroergometry and six-minute-walk-test (6MWT) were performed for a quantitative assessment of cardiac diastolic function and CRF. A significant correlation between weekly MET and QoL (r = 0.10; P = 0.05) and 6MWT-distance (r = 0.17; P = 0.002) was found, whereas no significant correlation with peak oxygen uptake (peakVO2) or cardiac diastolic function was observed. A further analysis separated patients into a low and a high weekly PA-group. For the low PA-group, no significant correlations between PA and any CRF- or QoL-parameters were found, whereas for the high PA-group, MET-values correlated significantly with QoL (r = 0.13; P = 0.01), 6MWT-distance (r = 0.21; p <0.001) and peakVO2 (r = 0.13; p = 0.02). Conclusively, everyday PA holds the potential to improve HFpEF-outcome and may therefore be a viable therapy option aside from pharmacological and interventional treatment. However, a certain PA-threshold must be exceeded to produce a benefit, as indicated by the separate analysis of patients with low and high levels of everyday PA.
Keywords: HFpEF; Diastolic Dysfunction; Physical Activity; HFpEF-Therapy