Document Type : Original Research

Authors

1 PhD Candidate, Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Cardiologist, Interventionist, Full professor, Clinical education improvement research center, Shiraz University of Medical Sciences, Shiraz, Iran

3 PhD of Biostatistics, Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran

4 PhD of Physiotherapy, Associated professor, Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

5 Rehabilitation Sciences Research Center, Shiraz University of Medical sciences, Shiraz, Iran

Abstract

Background: This study aims to evaluate the effect of exercise training on heart rate variability (HRV) and to determine the correlation between parameters of HRV and the ejection fraction in patients with heart failure after percutaneous coronary intervention.
Material and Methods: Fifty patients with left ventricular ejection fraction ≤ 40% undergone percutaneous coronary intervention were randomly allocated in either an exercise training (ET) group or a control group. The ET group performed exercise training for 45 minutes, three times a week for seven weeks. Patients in both groups received a leaflet for daily exercising at home. HRV parameters comprising, the standard deviation of normal R-R intervals (SDNN), the square root of the mean of the squares of successive R-R intervals differences (RMSSD) ,the percentage of successive R-R intervals differing from more than 50 ms (PNN50), using 24-hour Holter electrocardiographic monitoring was measured.
Results: After the intervention, the SDNN improved in the ET group (P=0.002), while changes in all remaining HRV indices were insignificant (P≥0.05). The control group showed no significant changes in any HRV parameters (P≥0.05). Changes in SDNN in the ET group were significantly different from the control group (P=0.003). At baseline, our results revealed a significant weak correlation between ejection fraction and SDNN (r =0.279, P=0.047). However, ejection fraction did not correlate significantly with RMSSD and PNN50.
Conclusion: Exercise training is safe and feasible in post percutaneous coronary intervention patients, even in those with reduced ejection fraction. In a seven-week period, exercise training was effective in improving HRV in heart failure patients after percutaneous coronary intervention.

Keywords

  1. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2014;46:517-92. doi: 10.1093/ejcts/ezu366. PubMed PMID: 25173601.
  2. He XM, Chen L, Luo JB, Feng XX, Zhang YB, Chen QJ, et al. Effects of rhBNP after PCI on non-invasive hemodynamic in acute myocardial infarction patients with left heart failure. Asian Pac J Trop Med. 2016;9:791-5. doi: 10.1016/j.apjtm.2016.06.006. PubMed PMID: 27569890.
  3. Kelly DJ, Gershlick T, Witzenbichler B, Guagliumi G, Fahy M, Dangas G, et al. Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Am Heart J. 2011;162:663-70. doi: 10.1016/j.ahj.2011.08.002. PubMed PMID: 21982658.
  4. Jewiss D, Ostman C, Smart NA. The effect of resistance training on clinical outcomes in heart failure: A systematic review and meta-analysis. Int J Cardiol. 2016;221:674-81. doi: 10.1016/j.ijcard.2016.07.046. PubMed PMID: 27423089.
  5. Smart N, Marwick TH. Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med. 2004;116:693-706. doi: 10.1016/j.amjmed.2003.11.033. PubMed PMID: 15121496.
  6. Lloyd-Williams F, Mair FS, Leitner M. Exercise training and heart failure: a systematic review of current evidence. Br J Gen Pract. 2002;52:47-55. PubMed PMID: 11791816; PubMed Central PMCID: PMC1314201.
  7. van Tol BA, Huijsmans RJ, Kroon DW, Schothorst M, Kwakkel G. Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. Eur J Heart Fail. 2006;8:841-50. doi: 10.1016/j.ejheart.2006.02.013. PubMed PMID: 16713337.
  8. Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM. A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. J Am Coll Cardiol. 2007;49:2329-36. doi: 10.1016/j.jacc.2007.02.055. PubMed PMID: 17572248.
  9. Hambrecht R, Hilbrich L, Erbs S, Gielen S, Fiehn E, Schoene N, et al. Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation. J Am Coll Cardiol. 2000;35:706-13. PubMed PMID: 10716474.
  10. Piepoli MF, Davos C, Francis DP, Coats AJ, ExTra MC. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 2004;328:189. doi: 10.1136/bmj.37938.645220.EE. PubMed PMID: 14729656; PubMed Central PMCID: PMC318480.
  11. Forslund L, Bjorkander I, Ericson M, Held C, Kahan T, Rehnqvist N, et al. Prognostic implications of autonomic function assessed by analyses of catecholamines and heart rate variability in stable angina pectoris. Heart. 2002;87:415-22. PubMed PMID: 11997407; PubMed Central PMCID: PMC1767117.
  12. Mäkikallio TH, Huikuri HV, Hintze U, Videbæk J, Mitrani RD, Castellanos A, et al. Fractal analysis and time-and frequency-domain measures of heart rate variability as predictors of mortality in patients with heart failure. Am J Cardiol. 2001;87:178-82.
  13. Weber F, Schneider H, von Arnim T, Urbaszek W. Heart rate variability and ischaemia in patients with coronary heart disease and stable angina pectoris; influence of drug therapy and prognostic value. TIBBS Investigators Group. Total Ischemic Burden Bisoprolol Study. Eur Heart J. 1999;20:38-50. PubMed PMID: 10075140.
  14. Munk PS, Butt N, Larsen AI. High-intensity interval exercise training improves heart rate variability in patients following percutaneous coronary intervention for angina pectoris. Int J Cardiol. 2010;145:312-4. doi: 10.1016/j.ijcard.2009.11.015. PubMed PMID: 19962772.
  15. Tsai MW, Chie WC, Kuo TB, Chen MF, Liu JP, Chen TT, et al. Effects of exercise training on heart rate variability after coronary angioplasty. Phys Ther. 2006;86:626-35. PubMed PMID: 16649887.
  16. Beckers PJ, Denollet J, Possemiers NM, Wuyts FL, Vrints CJ, Conraads VM. Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: a prospective randomized study. Eur Heart J. 2008;29:1858-66. doi: 10.1093/eurheartj/ehn222. PubMed PMID: 18515805.
  17. Feiereisen P, Delagardelle C, Vaillant M, Lasar Y, Beissel J. Is strength training the more efficient training modality in chronic heart failure? Med Sci Sports Exerc. 2007;39:1910-7. doi: 10.1249/mss.0b013e31814fb545. PubMed PMID: 17986897.
  18. Piepoli MF, Conraads V, Corra U, Dickstein K, Francis DP, Jaarsma T, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011;13:347-57. doi: 10.1093/eurjhf/hfr017. PubMed PMID: 21436360.
  19. Selig SE, Levinger I, Williams AD, Smart N, Holland DJ, Maiorana A, et al. Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure. J Sci Med Sport. 2010;13:288-94. doi: 10.1016/j.jsams.2010.01.004. PubMed PMID: 20227917.
  20. Adamopoulos S, Ponikowski P, Cerquetani E, Piepoli M, Rosano G, Sleight P, et al. Circadian pattern of heart rate variability in chronic heart failure patients. Effects of physical training. Eur Heart J. 1995;16:1380-6. PubMed PMID: 8746907.
  21. Larsen AI, Gjesdal K, Hall C, Aukrust P, Aarsland T, Dickstein K. Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability. Eur J Cardiovasc Prev Rehabil. 2004;11:162-7. PubMed PMID: 15187821.
  22. Murad K, Brubaker PH, Fitzgerald DM, Morgan TM, Goff DC, Jr., Soliman EZ, et al. Exercise training improves heart rate variability in older patients with heart failure: a randomized, controlled, single-blinded trial. Congest Heart Fail. 2012;18:192-7. doi: 10.1111/j.1751-7133.2011.00282.x. PubMed PMID: 22536936; PubMed Central PMCID: PMC3400715.
  23. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998;98:1510-6. PubMed PMID: 9769304.
  24. Buch AN, Coote JH, Townend JN. Mortality, cardiac vagal control and physical training--what’s the link? Exp Physiol. 2002;87:423-35. PubMed PMID: 12392106.
  25. Kingwell BA. Nitric oxide as a metabolic regulator during exercise: effects of training in health and disease. Clin Exp Pharmacol Physiol. 2000;27:239-50. PubMed PMID: 10779120.
  26. Townend JN, al-Ani M, West JN, Littler WA, Coote JH. Modulation of cardiac autonomic control in humans by angiotensin II. Hypertension. 1995;25:1270-5. PubMed PMID: 7768573.
  27. Kleiger RE, Stein PK, Bigger JT, Jr. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol. 2005;10:88-101. doi: 10.1111/j.1542-474X.2005.10101.x. PubMed PMID: 15649244.
  28. Enciu EC, Stanciu SM, Matei D, Costache A. Prognostic markers in the pathology of cardiac failure: echocardiography and autonomic nervous system dysfunction. Rom J Morphol Embryol. 2015;56:401-6. PubMed PMID: 26193205.