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AEROBIC TRAINING DECREASES AORTIC STIFFNESS IN PATIENTS WITH HEART FAILURE: PP.1.08

Objective: Patients with heart failure (HF) have an increased arterial stiffness and reduced endothelial function, both associated with an increased mortality. Aim of the study was to evaluate predictors of increased arterial stiffness in HF patients and the effect of aerobic physical training on vascular structure and function. Design and Methods: 28 patients with HF (age 61 ± 10 years, ischemic etiology 46%, ejection fraction-EF 35 ± 7%) were recruited. Seventeen patients completed a six-month training program at 60% of the peak oxygen uptake (VO2). Aortic (carotid to femoral) pulse wave velocity (PWV), endothelium-dependent and independent brachial artery dilation (flow-mediated dilation–FMD- and response to sublingual glyceril trinitrate–GTN- 25 μg respectively), plasma markers of neurohormonal activation, echocardiogram, and cardiopulmonary stress test were performed upon enrollment and at the sixth month. Results: Baseline PWV was not influenced by gender, but was higher in patients with ischemic than dilated cardiomyopathy, even after adjustment for age and blood pressure (BP); it was related to age (r = 0.72, p < 0.0001), systolic (r = 0.51, p = 0.01) and diastolic BP (r = 0.42, p = 0.04), peakVO2 (r = 0.51, p = 0.01), serum creatinine (r = 0.59, p = 0.002), and relative wall thickness (RWT, r = 0.54, p = 0.009), but not to FMD, response to GTN, EF, NTproBNP or plasma norepinephrine. In the multivariate analysis, age, serum creatinine, and RWT were independent predictors of PWV (full model r2 = 0.76). Training did not modify clinic BP but reduced mean (-4%, p < 0.05) and diastolic (-5%, p < 0.05) central BP, reduced aortic PWV (-10%, p < 0.05) and increased peakVO2 (+18%, p < 0.01), whereas FMD and response to GTN were unchanged. Conclusions: In HF aortic stiffness is associated to ischemic etiology, age, cardiac remodeling, renal function and reduced exercise tolerance, while endothelial function and neurohormonal activation seem to play a minor role. Six-month aerobic exercise training induces a reduction in aortic stiffness, accompanied to an improved exercise tolerance and reduced central BP values.