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Original Articles

Absence of Exercise Capacity Improvement After Exercise Training Program

A Strong Prognostic Factor in Patients With Chronic Heart Failure

Jean-Yves Tabet, MD; Philippe Meurin, MD; Florence Beauvais, MD; Hélène Weber, MD; Nathalie Renaud, MD; Gabriel Thabut, MD, PhD; Alain Cohen-Solal, MD, PhD; Damien Logeart, MD, PhD and Ahmed Ben Driss, MD, PhD

From the Les Grands Près, Centre de Réadaptation Cardiaque de la Brie (CRCB), Villeneuve-Saint-Denis, France (J.-Y.T., P.M., H.W., N.R., A.B.D.); Service de Cardiologie, Hôpital Lariboisiere, Faculté de Médecine Paris Diderot, INSERM 689, Paris, France (J.-Y.T., F.B., A.C.S., D.L.); and Service de Pneumologie, Hôpital Bichat, Faculté de Médecine Paris Diderot, Paris, France (G.T.).

Correspondence to Jean-Yves Tabet, MD, Centre de Réadaptation Cardiaque de la Brie, 27, Rue Sainte Christine, 77174 Villeneuve-Saint-Denis, France. E-mail jtabet{at}free.fr

Received February 26, 2008; accepted September 23, 2008.

Background— Exercise training is established as adjuvant therapy for chronic heart failure, but the prognostic value of improvement in exercise capacity after exercise training has never been evaluated.

Methods and Results— In this prospective bicentric study, all chronic heart failure patients with left ventricular ejection fraction <45% who underwent an exercise training program in a cardiac rehabilitation center between January 2004 and September 2006 were consecutively included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (PVO₂) and in PVO₂ expressed as a percentage of predicted PVO₂ (%PPVO₂) measured before and after the training program. We included 155 patients (54±12 years old, male 81%, left ventricular ejection fraction=29.5±7.1%). Patients underwent 20 (10–30) training sessions. PVO₂ and %PPVO₂ were significantly increased after the training program (14% and 13%, respectively, P<0.001 for both). After 16±6 months follow-up, 27 patients had a cardiac event (death [n=12], cardiac transplantation [n=5], hospitalization for acute heart failure [n=10]). Univariate analysis revealed that among 17 significant predictors of cardiac events, the 2 more powerful ones were level of B-type natriuretic peptide at baseline (P<0.0001) and improvement in exercise capacity as assessed by PVO₂ and %PPVO₂ (P<0.0001). Multivariate analysis revealed B-type natriuretic peptide level and %PPVO₂ as only independent predictive factors of outcome (P=0.01). The risk ratio of cardiac events for nonresponse versus response to the training program (defined as median %PPVO₂<6%) was 8.2 (P=0.0006).

Conclusions— Among patients with chronic heart failure, the lack of improvement in exercise capacity after an exercise training program has strong prognostic value for adverse cardiac events independent of classical predictive factors such as left ventricular ejection fraction, New York Heart Association class, and B-type natriuretic peptide level.

Key Words: heart failure • exercise

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