Влияние физических тренировок на функциональные и гемодинамические показатели пациентов с хронической сердечной недостаточностью III–IV функционального класса в зависимости от потребности в инотропной поддержке

Objective . To assess and compare the impact of physical training (PT) on functional and hemodynamic characteristics in patients with chronic heart failure (CHF) depending on continuous inotropic support. Design and methods . Prospective randomized study included 120 men aged 18–65, admitted to the Almazov National Medical Research Center (St Petersburg, Russia) from 2014 to 2019 due to decompensated CHF of III–IV functional class (FC), with left ventricular ejection fraction (LVEF) ≤ 30 %; blood pressure (BP) ≥ 90/60 mmHg (with or without inotropic therapy). Patients receiving dopamine or dobutamine for ≥ 2 weeks were randomized into two groups: group 1 participated in program of physical training (PPT), and group 2 did not participate in PPT. Patients of group 3 had CHF of III–IV class without inotropic therapy and participated in PPT. Initially, all groups were comparable by clinical, functional and hemodynamic parameters. The follow-up lasted 6 months. During months 3 and 6, hemodynamic parameters — BP and heart rate (HR), respiration rate (RR) at rest and peak of exercise, echocardiographic and central hemodynamics at rest, parameters at rest, number of arrhythmias were evaluated. Results . Patients of group 1, after 3 and 6 months, showed no increase in systolic (BPs) and mean BP (BPm) at peak of exercise, in contrast to patients of group 3 who demonstrated a significant increase in BPs (p ≤ 0,002) and BPm (p ≤ 0,005) after 3 months, and BPs (p ≤ 0,001) and BPm (p ≤ 0,002) after 6 months. By 6-month follow-up, intergroup analysis did not show significant changes in HR, LVEF, end-diastolic volume, stroke volume and pulmonary pressure. Initially, ECG monitoring showed a higher number of unstable ventricular tachycardia (VT) in group 1 compared with group 3 (p = 0,01), after 3 and 6 months in all groups the number of VT was comparable. During 6 months, implantable cardioverter defibrillator (ICD) shocks were compared in all groups: 2 per group (5 %). Conclusions . “Inotrope-dependent” survivors with CHF at peak of exercise did not significantly increase BPs and BPm in contrast to “inotrope-independent” patients. Individually developed aerobic PPT of low and intermediate intensity in “inotrope-dependent” survivors did not influence negatively on echocardiographic parameters, parameters of hemodynamics at rest and during the peak of exercise, did not increase mortality and number of life-threatening cardiac arrhythmias and ICD shocks.