Author + information
- Siu-Hin Wan, MD and
- Horng H. Chen, MB, BCh∗ ()
- ↵∗Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
We thank Dr. Pressler and colleagues for their interest in our paper (1). The progression of pre-clinical diastolic dysfunction (PDD) to symptomatic heart failure with preserved ejection fraction (HFpEF) is dependent on a variety of comorbid conditions, including pulmonary, renal, and hematologic dysfunction (1). Because exercise testing may be significant in the diagnosis and prognosis of HFpEF, it follows that cardiopulmonary rehabilitation may be an important nonpharmacological intervention.
Edelmann et al. (2) have demonstrated in their pilot multicenter trial of HFpEF subjects that exercise improves diastolic function parameters as well as the outcomes of exercise capacity and quality of life. In their letter, they emphasize the importance of exercise training for those with diastolic dysfunction.
Cardiac rehabilitation has been shown to have beneficial effects on symptomatic heart failure as well as on coronary artery disease. However, its benefit in patients with stage B or pre-clinical heart failure remains undefined. Benefits of exercise include, not only enhanced cardiac function, but also increased minute ventilation and oxygen utilization, and improved endothelial, neuroendocrine activity, and muscle metabolism (3). Because the underlying pathophysiology of PDD progression is dependent on multiple organ systems, cardiopulmonary exercise therefore may indeed provide, not only diastolic function benefits, but also pulmonary, hematologic, and renal benefits as well.
Dr. Pressler and colleagues highlight that an important aspect of PDD and HFpEF management is nonpharmacological intervention. In addition to exercise, other basic nonpharmacological interventions, such as education, diet, fluid restriction, alcohol and smoking cessation, and appropriate vaccinations, may also be important in the cessation of the downward heart failure spiral (4).
Further studies are needed to better characterize which of the underlying physiological benefits of cardiopulmonary exercise directly contribute to the reduction of heart failure progression, which may lead to directed exercise activities specifically to better target cardiac, pulmonary, or hematologic dysfunction.
- American College of Cardiology Foundation
- Wan S.H.,
- Vogel M.W.,
- Chen H.H.
- Edelmann F.,
- Gelbrich G.,
- Dungen H.D.,
- et al.
- Ileana L.,
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- American Heart Association Committee on exercise, rehabilitation, and prevention
- Gibbs C.R.,
- Jackson G.,
- Lip G.Y.H.