Evaluation of the Effects of a Cardiac Rehabilitation program with Combined Training on Left Ventricular mass in Patients with Heart Failure

Background and Aim: Heart failure (HF) is a chronic, multisystemic, heterogeneous, and progressive syndrome where sustained activation of compensatory neurohormonal mechanisms leads to maladaptive left ventricular remodeling. There is evidence that regular exercise stimulates physiological cardiac growth, increases mitochondrial biogenesis, mitophagy, and improves mitochondrial dynamics in healthy hearts. However, its effects on left ventricular mass and the relationship with peak VO2 gains, specifically with combined training in HF patients, have not been elucidated. Therefore, the aim of the study is to assess whether a cardiac rehabilitation program (CRP) with combined training can increase left ventricular mass and thereby peak oxygen consumption (VO2p) in patients with HF. Materials and Methods: A quasi-experimental, non-controlled study was conducted in chronic HF patients who completed the supervised phase 2 of the CRP. Participants underwent transthoracic echocardiography and a cardiopulmonary exercise test with gas analysis (CPET) where echocardiographic variables such as mass, end-diastolic volume, posterior wall thickness and interventricular septal thickness of the left ventricle were measured, as well as cardiopulmonary exercise variables such as VO2p, VT1, VAT, VT2, FATmax and crossover, at admission and discharge. Results: A total of 50 patients diagnosed with HF were included, 70% men, with a mean age of 63.9 ± 11.7 years. In the inferential analysis between baseline parameters and after completing the CRP, significant differences were found in LVEF (p <0.001), end diastolic volume (p <0.001), left ventricular mass indexed to total body surface area (p <0.001), oxygen pulse (p <0.001), Mets-C (p <0.001), VT1 (p = 0.013), VAT (p = 0.002), VT2 (p <0.001), FATmax (p = 0.003), and crossover (p <0.001). VO2 peak behavior was analyzed in patients who had an increase in ventricular mass (n=17) compared to those who had a decrease in ventricular mass (n=33), finding both groups had statistically significant changes in VO2 peak (p = 0.04). Conclusions: CRPs based on combined physical training are effective and safe in patients with chronic HF, improving peak VO2 in clinically stable patients regardless of changes in left ventricular geometry measured through left ventricular mass. While the most frequently presented adaptation at the end of the intervention was reverse remodeling, this condition does not contravene the gains in cardiorespiratory fitness, as this ventricular mass could generate greater fitness and aerobic power.