Fitness in chronic heart failure : effects of exercise training and of biventricular pacing

Gademan, M. (2009)

Doctoral Thesis

In CHF patients exercise capacity is decreased (low physical fitness). The degree of exercise intolerance in CHF is paralleled by an increased mortality, moreover, several studies suggest that increasing exercise capacity in CHF improves prognosis. Therefore, improving exercise capacity is one of the major issues in CHF-related treatment. Besides this decreased exercise capacity CHF patients also have a low autonomic fitness (high neurohumoral activation and a low baroreflex sensitivity (BRS)), which causes structural end-organ damage and increases mortality. The current therapeutic regimen in CHF mainly focuses on the blocking of the neurohumoral activation but not on the removing of neurohumoral activation. In this thesis we have studied the effects of exercise and cardiac resynchronization therapy (CRT) on both physical and autonomic fitness in CHF patients. We found that exercise improves both physical and autonomic fitness. Also, we showed that is possible to increase BRS without actual exercise, by mimicking exercise associated nerve traffic by means of TENS (transcutaneous electrical nerve stimulation). Furthermore, we found that CRT acutely improves BRS, and this improvement had predictive value for the anatomical response after six months of CRT. In conclusion, both exercise and CRT are capable to improve the fitness of CHF patients

• Baroreflex sensitivity
• Biventricular pacing
• Exercise training
• Heart failure,
• Neurohumoral activation
• Oxygen uptake efficiency slope
• Oxygen uptake-work relation

• All authors: Gademan, M.
• Supervisor: Wall, E.E. van der; Schalij, M.J.
• Co-supervisor: Swenne, C.A.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2009-06-17
• ISBN (print): 9789090242507
• Sponsorship: Nederlandse Hartstichting JE Jurriaanse Stichting