EVALUATION OF THE EFFECTIVENESS OF THE EFFECT OF PHYSICAL ACTIVITY ON FUNCTIONAL STATUS, CYTOKINE PROFILE AND COURSE OF CHRONIC HEART FAILURE WITH DIFFERENT EJECTION FRACTIONS
- Authors: Drobysheva V.R.1, Glavatskikh Y.O.1, Tokmachev R.E.1, Budnevskaya S.A.1
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Affiliations:
- VSMU named after N.N. Burdenko
- Issue: Vol 11 (2022): Materials of the XVIII International Burdenkov Scientific Conference on April 14-16, 2022
- Pages: 616-618
- Section: Medicine without frontiers
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/7437
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Abstract
Relevance The progression of chronic heart failure (CHF) is associated with repeated hospitalizations and a decrease in the quality and duration of life. In this regard, the search and development of effective treatment and prevention programs are relevant and necessary today.
The research objective To assess the effect of physical training on the clinical course, laboratory and instrumental parameters in patients with CHF with preserved (CHFpEF) reduced (CHFrEF) ejection fraction.
Methods The study included 160 patients with CHF (86 men and 74 women) with an average age of 72.2±8.8 years. The separation into groups was made on the basis of the left ventricular ejection fraction (LV EF). In each group, two subgroups were formed depending on the inclusion in the therapeutic program of physical training. At the time of inclusion and after 12 months, a determination of exercise tolerance, laboratory and instrumental examination were carried out. Statistical analysis was carried out using the Statistica 10 software package.
Results Re-examination after 12 months in subgroups undergoing physical rehabilitation revealed a statistically significant (p≤0.05) decrease in the level of N end fragment of natriuretic peptide (NT-proBNP), highly sensitive C-reactive protein (hs-CRP), interleukin-1 β (IL1 β), interleukin-6 (IL6), tumor necrosis factor - alpha (TNF - alpha). There was an increase in exercise tolerance , evaluated using 6MWT.
Conclusion Physical rehabilitation in patients with CHF with both preserved and reduced LV FV is accompanied by a significant improvement in the clinical course, an improvement in stress tests (6MWT), a decrease in the level of pro-inflammatory cytokines, hs-CRP, NT-proBNP.
Keywords
Full Text
Relevance
Physical training is recommended for patients with heart failure in accordance with the principles and rules for the management of patients with CHF. They improve exercise tolerance, patient quality of life, reduce symptoms of depression, and may reduce the risk of hospitalization [1]. There are many options for cardiorehabilitation based on physical exercises, so the medical literature describes in detail continuous and interval aerobic exercise, training of the respiratory muscles [2]. However, despite the numerous benefits of exercise training, exercise-based programs are not widely used due to various factors. Biomarkers in CHF are used both for diagnosis and stratification of risk, and to assess the effectiveness of treatment programs [2].
The research objective
To assess the effect of physical training on the clinical course, laboratory and instrumental parameters in patients with CHF with preserved (CHFpEF) reduced (CHFrEF) ejection fraction
Methods
The study included 160 patients with CHF (86 men and 74 women) with an average age of 72.2±8.8 years. Patients were divided into two groups depending on LV FV, so the first group (group 1) included patients with chronic heart failure with a preserved ejection fraction (CHFpEF, FV≥50%) it was 69 patients, in the second (group 2) - 91 patients with chronic heart failure with a reduced ejection fraction (CHFrEF, FV<50%). An additional division into two subgroups (a and b) was made on the basis of inclusion in the treatment program of physical training. Both groups received standard drug therapy, in accordance with the clinical recommendations of RKO [3]. Exercise tolerance (TPA) was determined twice (at the switching-on stage and after 12 months), using a complex of cardiorespiratory analysis and a monitoring system for patients with CHF and a 6-minute walk test (6MWT), laboratory (general clinical and enzyme-linked immunosorbent blood tests with the determination of natriuretic peptide (NT-proBNP), highly sensitive C-reactive protein (hs-CRP), interleukin-1β (IL1β), interleukin-6 (IL6), tumor necrosis factor - alpha (alpha-TNF) and instrumental examination (Echo-KG, where the mass, size and volume of the myocardium (by departments), LV EF, indicators of myocardial diastolic dysfunction were evaluated). Consent to voluntary participation in the study was signed by all patients. Statistical analysis is carried out using the Statistica 10 software package. The normality of the distribution of data was assessed using a test (Shapira-Wilke). The original continuous variables were represented as a mean±standard deviation and compared using Student's t-criterion. Differences between subgroups were considered statistically significant at a significance level of p<0.05.
The results and discussion
When comparing the level of NT-proBNP in both groups again, it was found that in patients with CHFrEF undergoing additional physical rehabilitation, it was 897±136 ng / l, in patients with CHFpEF - 476±82 ng / l, the differences were statistically significant (p<0.001). The average level of NT-proBNP in subgroups b also differed statistically significantly and amounted to in patients with CHFrEF 1129±185 ng/L and 796±121 ng/L in patients in the CHFpEF group (p<0.001).
During the research, the dynamics of the level of the biomarker of endogenous inflammatory processes of highly sensitive C-reactive protein in all 4 subgroups of patients was studied. When re-examining patients, it was revealed that in the subgroup of patients with CHFpEF who underwent additional physical rehabilitation (subgroup 1. a), the level of hs-CRP significantly decreased by 2.9±0.56 mg / l (p<0.05 compared with 2020), while in patients receiving exclusively drug therapy (subgroup 1b), statically significant changes could not be detected by 3.6±0.62 mg / l. In patients with CHFrEF undergoing additional physical rehabilitation (subgroup 2. a) the level of highly sensitive C-reactive protein was statistically significantly lower – 2.05±0.48 mg / l (p<0.01, compared with subgrowth. 2. b; p<0.05 and compared to Subgr. 2 in 2020). It is worth noting that the hs-CRP level of patients with CHFrEF who received exclusively drug therapy also significantly decreased by 2.2±0.51 mg / l (p<0.001, compared with subgroup 2 in 2020).
A study of biomarkers of inflammation showed the following differences: il 1B levels in patients with CHFpEF undergoing additional physical rehabilitation (subgroup 1. a), was 106.9± 21.8 pg/mL, which was significantly higher than its value in patients with CHFrEF (subgr.2. a) – 95.8±20.1 pg/ml (p<0.04). In the subgroups that did not undergo physical rehabilitation, the level of this marker was also higher in the subgroup CHFpEF 121.9± 25.4 pg / ml, against CHFrEF 103.1± 21.0 pg / ml (subgr.2. b) (p<0,05).
Similar and statistically significant differences (p<0.05) were obtained for the level of IL6 markers, and TNF-α. So IL6 in patients with CHFpEF who underwent additional physical rehabilitation (subg.1. (a), was 261.4±31.4 pg/mL, versus 167.6±26.3 pg/mL CHFrEF (Subgr.2. a). In the subgroups that did not undergo physical rehabilitation, the level of this marker was also higher in the CHFpEF subgroup of 295.2±35.1 pg / ml and 182.1± 28.8 pg / ml, respectively, in the CHFrEF group.
TNF-α in subgroup 1. a (CHFpEF) was 145.4± 25.1 pg/mL, versus 130.7± 22.8 pg/mL CHFrEF (Subgr.2. b). In the subgroups that did not undergo physical rehabilitation, the level of this marker was also higher in the CHFpEF subgroup of 163.4± 27.2 pg / ml and 143.0± 24.9 pg / ml, respectively, in the CHFrEF group.
Upon re-examination, there was a significant statistically significant improvement in the functional status of patients who underwent additional physical rehabilitation, estimated at 6MWT. Thus, the distance traveled within 6 minutes, / the ratio of 6MWD / 6MWD (i) in patients with an isolated course of CHF, who underwent additional physical rehabilitation, regardless of FV, statistically significantly improved, as in comparison with control subgroups (1. b, 2. b) (p1 = 0.04; p2 = 0.005 / p1 = 0.01; p2 = 0.02) and in comparison with the initial indicators in the initial examination of patients (p<0.001).
A decrease in the NT-proBNP biomarker obtained during research in groups of patients undergoing physical rehabilitation may indicate a positive effect on the course of CHF of properly selected physical activity.
Higher levels of IL-1β, IL-6, TNF-α, hs-CRP in subgroups of patients with CHFpEF and compared to subgroups with CHFrEF may reflect the significance of the contribution of systemic inflammation to the development and progression of HF.
In groups of patients who additionally underwent physical rehabilitation, the content of biomarkers of systemic inflammation significantly decreased in comparison with the group receiving exclusively drug therapy.
When re-examining patients, there was a significant statistically significant improvement in the functional status of patients who underwent additional physical rehabilitation, estimated in 6MWT. This fact can be explained by a decrease in the activity of systemic subclinical inflammation (described above), which, on the one hand, reduces the reduction in muscle mass of the body.
Conclusion
Comparison of biomarkers of inflammation in patients with CHFpEF and CHFrEF reflects the contribution of the immune-inflammatory component to the development and progression of CHF, as indicated by higher levels of hs-CRP, a pro-inflammatory cytokine in patients with CHFpEF.
Physical rehabilitation in patients with CHF with both preserved and reduced LV EF is accompanied by a significant improvement in the tolerability of physical activity, an improvement in hemodynamics during stress tests (6MWT), a decrease in the level of pro-inflammatory cytokines, NT-proBNP.
About the authors
Valeria R. Drobysheva
VSMU named after N.N. Burdenko
Email: drobyshevavr@gmail.com
ORCID iD: 0000-0001-6636-6644
SPIN-code: 1262-6060
Russian Federation
Yuliya O. Glavatskikh
VSMU named after N.N. Burdenko
Email: Yuliyag36@gmail.com
ORCID iD: 0000-0002-2398-5987
SPIN-code: 9762-6156
Russian Federation
Roman E. Tokmachev
VSMU named after N.N. Burdenko
Email: r-tokmachev@mail.ru
ORCID iD: 0000-0001-6379-4635
SPIN-code: 5922-6679
Sofia A. Budnevskaya
Author for correspondence.
Email: Yuliyag36@gmail.com
ORCID iD: 0000-0003-3649-5642
SPIN-code: 1111-1111
References
- Drobysheva E.S., Tokmachev R.E., Budnevsky A.V., Kravchenko A.Ya. Prognostic value of cardiac cachexia biomarkers in chronic heart failure. Cardiovascular therapy and prophylaxis. 2016; 15(4): 80-83. (In Russ.)
- Drapkina O.M., Koncevaya A.V., Kravchenko A.YA., et al.// Biomarkers st2 and interleukin 33 in assessing cardiac inflammation, fibrosis and prognosis in patients with heart failure Rossijskij kardiologicheskij zhurnal. 2021; 26.(S3): 79-85. (In Russ.)
