Structured Exercise Training Improves LVEF and LDL-C in HFmrEF Patients After PCI
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Key Takeaway
Consider adding a 52-week structured exercise program to GDMT for stable CAD patients with HFmrEF post-PCI to improve LVEF and LDL-C.
This single-center randomized controlled trial enrolled 120 stable coronary artery disease patients with heart failure with mildly reduced ejection fraction (LVEF 40-49%) who had undergone percutaneous coronary intervention. Participants were randomized to receive guideline-directed medical therapy plus a 52-week structured exercise program or GDMT alone.
After 52 weeks, the exercise group showed a significantly greater improvement in LVEF (interaction p = .023) with a mean increase of +5.0% versus +4.0% in controls. LDL-C reduction was also greater in the exercise group (-1.43 mmol/L vs. -1.04 mmol/L, p = .030). No significant between-group differences were observed for triglycerides or LV end-diastolic diameter.
Safety data including adverse events, serious adverse events, and discontinuations were not reported, limiting assessment of tolerability. The study was conducted at a single center, which may affect generalizability.
Despite these limitations, the results suggest that adding a sustained structured exercise program to GDMT may offer additional benefits in LVEF recovery and lipid control for this specific post-PCI population. Clinicians should consider exercise referral as part of comprehensive management, but larger multicenter trials are warranted to confirm these findings.
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View Original Abstract ↓
BACKGROUND: Exercise-based cardiac rehabilitation (ExCR) is standard for secondary prevention in coronary artery disease (CAD), yet its efficacy in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after percutaneous coronary intervention (PCI) remains unclear.
METHODS: In this single-center RCT, 120 stable CAD patients with HFmrEF (LVEF 40-49%) post-PCI were randomized 1:1 to receive either guideline-directed medical therapy (GDMT) plus a 52-week structured ExCR program (intervention) or GDMT alone (control). Primary outcomes-LDL-C, TG, LVEF, and LVEDD-were assessed at 4, 12, 24, and 52 weeks. Linear Mixed Models analyzed longitudinal intervention effects.
RESULTS: A significant Group × Time interaction was observed for LVEF (p = .032), indicating superior recovery in the ExCR group. At 52 weeks, the ExCR group showed greater improvement in LVEF (+5.0% vs. +4.0%, p = .023) and greater reduction in LDL-C (-1.43 mmol/L vs. -1.04 mmol/L, p = .030) versus control. No between-group differences were found in TG or LVEDD.
CONCLUSIONS: A 52-week structured ExCR program significantly enhances cardiac recovery and lipid control in HFmrEF patients post-PCI, providing incremental benefits beyond GDMT alone. Sustained ExCR should be considered essential in comprehensive management for this population.
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