P6036Physical exercise- mediated effects on left ventricular diastolic function outweigh other modifiable risk factors in coronary artery disease patients

Abstract

Background: Patients with coronary artery disease (CAD) have a high prevalence of diastolic dysfunction because both CAD and diastolic dysfunction share similar etiologic risk factors including obesity, hypertension and diabetes. Because diastolic dysfunction is a precursor of heart failure with preserved ejection fraction, an important issue is stop the progression of disease. The significance of exercise-mediated effects on an impaired left ventricular (LV) diastolic function in comparison with common risk factors in CAD is matter of investigation. Purpose: To evaluate whether the effect of regular physical exercise on diastolic function outweighs the other modifiable risk factors in a referral CAD population. Methods: In cooperation with Germany's largest health insurance company, patients with known CAD were asked to participate in a six-month endurance and resistance exercise program. Baseline self-reported physical activity level was recorded through questionnaire. Peak trans-mitral early (E) and atrial (A) diastolic flow velocity as well as early mitral (lateral and medial) annulus velocity (e') were measured and E/A and E/e' calculated. Cardiopulmonary exercise testing was performed to determine peak oxygen consumption (VO2 peak). Patients were stratified into two groups based on a threshold of 150 min/wk of moderate to vigorous physical activity. Univariate linear regression analysis was performed for the entire sample. Results: 467 individuals (17% female) with a mean age of 67.1±9.8 (36-86 y) were analyzed retrospectively. Mean VO2peak was 23.0±7.4ml/kg/min and mean maximal workload 124.6±40.7 W. Mean LVEF was 56.9±5.2%. Mean E/e' was 9.5±3.2 and 50 patients (14%) had symptoms of exertional dyspnea. There was a good correlation between weekly physical activity and exercise capacity (r2=0,49, p<0.001). In a logistic regression model including all patients, peak oxygen consumption as well as weekly physical activity outweighed the other modifiable risk factors diabetes, hypertension and obesity. E/e' was significantly lower in patients who performed ≥150 min/week of physical exercise (n=220) compared to <150 min/week (8.6±2.7 vs 10.3±3.5, 95% CI 1.1-2.4, p<0.001). For every increase of 10 min of physical activity per week, E/e' decreased by 4%. Conclusions: CAD-patients who perform regular physical exercise ≥150 min/week have significantly better left ventricular diastolic function measured by E/e'. Higher VO2 peak as well as higher weekly physical exercise outweighed the other modifiable cardiovascular risk factors obesity, diabetes and hypertension in this high-risk patient population.