Cardiopulmonary exercise testing combined with echocardiography and response after a cardiac rehabilitation program in chronic heart failure patients

Exercise training is strongly recommended to improve quality of life in chronic heart failure (CHF) patients. The magnitude of improvement of peak oxygen consumption (VO2) is highly variable between patients and a lack of response to training has been described as a predictor of poor prognosis. We aimed at evaluating the efficiency of an experimental approach combining cardiopulmonary exercise testing (CPET) and echocardiography to detect non-responder patients. Forty-one CHF patients (88% male, 57 ± 12 yrs) referred to cardiac rehabilitation were recruited to perform CPET-echocardiography before and after 20 exercise training sessions. Patients underwent 2 CPET-echocardiography using a ramp protocol on a semi-supine bicycle. Measures were performed at rest, at the ventilator threshold 1 (VT1) and at peak exercise for VO2, CO2 output, ventilation, heart rate, blood pressures, cardiac output, left ventricular (LV) filling pressure (E/A, E/e’), LV global strain, LV ejection fraction and pulmonary pressure ( Table 1 ). Cardiac rehabilitation program included exercise training (ET), patients’ education, diet and psychosocial counselling. The ET combined endurance (continuous form, 2 sessions/week and interval form, 3 sessions/week) and resistance sessions. After the ET, VO2 peak increased from 16 ± 5 to 20 ± 6 ml/kg/min (P