Safety and effectiveness of physical training in inotrop-dependent patients with compensation for chronic heart failure at the level of the III-IV functional class

Abstract


Aim. To assess the safety and effectiveness of physical training in inotrop-dependent patients with stabilization of the course of chronic heart failure (CHF) at the level of the III-IV functional class (FC). Materials and methods. The prospective randomized study included men of 18-65 years old who were committed to Almazov National medical research center "due to decompensated CHF III-IV FC, left ventricular ejection fraction of 30% or less due to coronary heart disease or dilated cardiomyopathy receiving dopamine or dobutamine for 2 weeks or more, stabilizing heart failure at level III-IV FC and arterial pressure 90/60 mm Hg and above against the background of ongoing inotropic therapy. Patients were randomized into 2 groups: 1st - those participating in the physical rehabilitation program (PRP), 2nd - receiving standard CHF therapy. Results. There was no increase in the number of fatal cases and the number of patients with episodes of decompensation of CHF in the 1st group compared with the 2nd group. The number of episodes of CHF decompensation before FC IV was higher in the 2nd group compared to the 1st: 13 (50%) in the 1st group and 20 (80%) in the 2nd (p=0.04). Episodes of CHF decompensation, requiring transfer to the anesthesiology and resuscitation departments, were 2 times less frequent in patients of the 1st group compared to the 2nd: 8 (31%) and 16 (64%), respectively (p=0.03). In patients with the 1st group, malignant ventricular arrhythmias were not registered during physical training and for 3 hours after their completion. There was a tendency (without achieving a statistically significant difference) to a decrease in pulmonary thromboembolism episodes in patients of the 1st group compared with the 2nd (p=0.05). In the 1st group, after 6 months, there was a decrease in the number of lower respiratory tract infections - bronchitis + pneumonia compared with the 2nd group (p=0.0006). Conclusion. Participation of inotropic-dependent patients in individually designed RPF does not increase their mortality and does not increase their number of life-threatening cardiac rhythm disturbances. In the group of inotropic-dependent patients participating in RPF, there was a significant decrease in the number of lower respiratory tract infections and a tendency to a decrease in the number of pulmonary embolism compared with patients not participating in RPF.

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About the authors

Mariia A. Bortsova

Almazov National Medical Research Center

Email: marja_@mail.ru
Saint Petersburg, Russia
Head of the Cardiology Department №8

Elena A. Demchenko

Almazov National Medical Research Center

Email: elenademchenko2006@rambler.ru
Saint Petersburg, Russia
D. Sci. (Med.)

Petr A. Fedotov

Almazov National Medical Research Center

Email: drheart@mail.ru
Saint Petersburg, Russia
Cand. Sci. (Med.)

Olga S. Ganenko

Almazov National Medical Research Center

Email: oganenko@rambler.ru
Saint Petersburg, Russia
Head of Department

Tatiana A. Lelyavina

Almazov National Medical Research Center

Saint Petersburg, Russia
Cand. Sci. (Med.)

Viktoriia L. Galenko

Almazov National Medical Research Center

Email: vicka.galenco@yandex.ru
Saint Petersburg, Russia

Sergei G. Zamesov

City Hospital №26

Saint Petersburg, Russia
cardiologist

Oksana A. Babich

Almazov National Medical Research Center

Saint Petersburg, Russia
nurse

Mariia Yu. Sitnikova

Almazov National Medical Research Center

Email: drsitnikova@mail.ru
Saint Petersburg, Russia

References

  1. Jugdutt B.I, Michorowski B.L, Kappagoda C.T. Exercise training after anterior Q wave myocardial infarction: importance of regional left ventricular function and topography. J Am Coll Cardiol 1988; 12: 362-72. https: //doi.org/10.1016/0735-1097 (88)90407-X
  2. Lewinter C, Doherty P, Gale C.P et al. Exercise-based cardiac rehabilitation in patients with heart failure: a meta-analysis of randomised controlled trials between 1999 and 2013. Eur J Prev Cardiol 2015; 22 (12): 1504-12. DOI: 10.1177/ 2047487314559853
  3. Мареев В.Ю, Агеев Ф.Т., Арутюнов Г.П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Утверждены на Конгрессе ОССН 7 декабря 2012 г., на Правлении ОССН 31 марта 2013 г. и Конгрессе РКО 25 сентября 2013 г. Сердечная недостаточность. 2013; 14 (7): 379-472. doi: 10.18087/rhfj. 2013.7.1860 @@Mareev V.Iu, Ageev F.T., Arutiunov G.P. et al. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Utverzhdeny na Kongresse OSSN 7 dekabria 2012 g., na Pravlenii OSSN 31 marta 2013 g. i Kongresse RKO 25 sentiabria 2013 g. Serdechnaia nedostatochnost'. 2013;(7): 379-472. doi: 10.18087/rhfj. 2013.7.1860 (in Russian)
  4. Мареев В.Ю., Фомин И.В., Агеев Ф.Т. и др. Клинические рекомендации. Хроническая сердечная недостаточность (ХСН). Сердечная недостаточность. 2017; 18 (1): 3-40. doi: 10.18087/rhfj.2017.1.2346 @@Mareev V.Iu., Fomin I.V., Ageev F.T. et al. Klinicheskie rekomendatsii. Khronicheskaia serdechnaia nedostatochnost' (KhSN). Serdechnaia nedostatochnost'. 2017; 18 (1): 3-40. doi: 10.18087/rhfj.2017.1.2346 (in Russian)
  5. Yancy C.W, Jessup M, Bozkurt B et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62 (16): e147-239. DOI: 10.1016/j. jacc. 2013.05.019
  6. Ponikowski P, Voors A.A, Anker S.D et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Fail-ure Association (HFA) of the ESC. Eur Heart J 2016; 37 (27): 2129-200. doi: 10.1093/eurheartj/ehw128
  7. Костомаров А.Н., Симоненко М.А., Федотов П.А. Факторы риска смерти пациентов, находящихся в листе ожидания трансплантации сердца. Научно-практический рецензируемый медицинский журнал «Трансляционная медицина»: Всероссийская молодежная медицинская конференция с международным участием «Алмазовские чтения - 2018». Май 2018. Прил. №3; с. 200. @@Kostomarov A.N., Simonenko M.A., Fedotov P.A. Faktory riska smerti patsientov, nakhodiashchikhsia v liste ozhidaniia transplantatsii serdtsa. Nauchno-prakticheskii retsenziruemyi meditsinskii zhurnal "Transliatsionnaia meditsina": Vserossiiskaia molodezhnaia meditsinskaia konferentsiia s mezhdunarodnym uchastiem "Almazovskie chteniia - 2018". Mai 2018. Pril. №3; p. 200 (in Russian)
  8. Piepoli M.F, Conraads V, Corra U et al. Exercise training in heart failure: from theory to practice. A consensus document of Heart Failure Association and European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011; 13 (4): 347-57. doi: 10.1093/eurjhf/hfr017
  9. McCormick Z.L, Chu S.K, Goodman D et al. An Appropriate Population for Acute Inpatient Rehabilitation? A Case Series of Three Patients With Advanced Heart Failure on Continuous Inotropic Support. PM & R 2015; 7: 662-6. http: //dx.doi.org/10.1016/j.pmrj.2015.01.006
  10. Shah M.R, OꞌConnor C.M, Sopko G et al. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE): Design and rationale. Am Heart J 2001; 141 (4): 528-35. https: //doi.org/10.1067/ mhj.2001.113995
  11. O’Connor C.M, Gattis W.A, Uretsky B.U et al. Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: Insights from the Flolan International Randomized Survival Trial (FIRST). Am Heart J 1999; 138: 78-86.
  12. Davies E.J, Moxham T, Rees K et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail 2010; 12 (7): 706-15. doi: 10.1093/eurjhf/hfq056

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