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Impact of an exercise training program on cardiac neuronal function in heart failure patients on optimal medical therapy

A randomized Iodine-123 metaiodobenzylguanidine scintigraphy study

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The syndrome of heart failure (HF) is characterized by left ventricular dysfunction and a compensatory chronic over activation of the sympathetic nervous system. We wanted to investigate if the beneficial effects of exercise training (ET) in HF patients on optimal medical therapy (OMT) are associated with alterations in cardiac sympathetic activity.

Methods

Cardiac sympathetic activity was evaluated at baseline and after 12 weeks using metaiodobenzylguanidine scintigraphy in 23 patients with stable HF participating in the SmartEx trial. Patients with HF in New York Heart Association class II or III and left ventricular ejection fraction <35 % were randomized to three different ET groups.

Results

We found no statistically significant changes in cardiac sympathetic activity after 12 weeks of ET. Heart to mediastinum (H/M) ratio at 15 minutes (0.00174 ± 0.0841, P = 0.922), H/M ratio at 4 hours (−0.00565 ± 0.1163, P = 0.818) and washout ratio (WR) (−1.2666 ± 16.5412, P = 0.717). A further group-wise analysis of the three ET groups did not show any difference between the groups.

Conclusion

A 12-week ET program did not alter the abnormal cardiac sympathetic activity in stable HF patients on modern OMT.

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Abbreviations

HF:

Heart failure

ET:

Exercise training

MIBG:

Iodine-123-metaiodobenzylguanidine

H/M:

Heart to mediastinum ratio

WR:

Washout ratio

LVEF:

Left ventricle ejection fraction

NE:

Norepinephrine

VO2peak :

Peak oxygen uptake

OMT:

Optimal medical therapy

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Acknowledgements

Stavanger Health Research: Åse Marit Brøndbo, Anne Haugland, and Marit Kristiansen for their help and contributions during exercise training. Jorunn Nilsen for coordinating, testing, and helping with examinations. Torbjørn Aarsland for CPET examinations. The staff at the Department of Nuclear Imaging, Stavanger University Hospital: Randi Ursin, Jan Erik Berge, Azora Marie Ramsvik, and Hilde Ødegård. Stavanger University: Jan Terje Kvaløy and Lena Bache-Mathiesen for statistical advice. Camilla Normand for linguistic advice.

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Authors and Affiliations

  1. Department of Cardiology, Stavanger University Hospital, Armauer Hansens vei 20, PO Box 8100, 4068, Stavanger, Norway

    Torstein Valborgland MD, Kjetil Isaksen MD, PhD & Alf Inge Larsen MD, PhD

  2. Department of Clinical Science, University of Bergen, Bergen, Norway

    Torstein Valborgland MD, Kjetil Isaksen MD, PhD & Alf Inge Larsen MD, PhD

  3. Sørlandet Hospital HF, Kristiansand, Norway

    Peter Scott Munk MD, PhD

  4. Department of Radiology, Stavanger University Hospital, Stavanger, Norway

    Zbigniew Piotr Grabowski MD

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  1. Torstein Valborgland MD
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  2. Kjetil Isaksen MD, PhD
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  3. Peter Scott Munk MD, PhD
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  4. Zbigniew Piotr Grabowski MD
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  5. Alf Inge Larsen MD, PhD
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Correspondence to Torstein Valborgland MD.

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Disclosure

Torstein Valborgland, Kjetil Isaksen, Peter Scott Munk, Zbigniew Piotr Grabowski and Alf Inge Larsen have no conflict of interest.

Additional information

Clinical trial registration information: a sub study of the SmartEx trial: Clinical trials.gov NCT00917046, https://clinicaltrials.gov/ct2/show/NCT00917046

Funding: This work was supported by Western Norway Regional Health Authority [Grant Number 911 715].

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Valborgland, T., Isaksen, K., Munk, P.S. et al. Impact of an exercise training program on cardiac neuronal function in heart failure patients on optimal medical therapy. J. Nucl. Cardiol. 25, 1164–1171 (2018). https://doi.org/10.1007/s12350-016-0724-8

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  • DOI: https://doi.org/10.1007/s12350-016-0724-8

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