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Background: Heart failure (HF) imposes limitations due to severe dyspnea and fatigue, which are often linked to diminished exercise tolerance, potentially influenced by compromised microvascular density, blood flow, and muscle strength. Myofascial release techniques (MRT) have demonstrated the capacity to enhance blood flow by reducing fascial tension., Purpose: To assess the impact of incorporating MRT into Circuit Resistance Training (CRT) in comparison to an unsupervised home-based rehabilitation (RUHB) program on exercise tolerance (ET), muscle strength (MS), quality of life (QoL), and depression in patients with HF., Methods: A randomized clinical trial involved HF patients with reduced ejection fraction (HFrEF, ejection fraction <50%) and NYHA classes II-IV. Participants were randomly assigned to either CRT (performing 2 circuits of 8 exercises thrice a week for three months) or CRT+MRT (receiving a combination of CRT and 6 MRT interventions once a week). Assessments included cardiopulmonary exercise tests (CPET) to measure ET, MS evaluated through One Repetition Maximum (1RM), QoL using the Minnesota Living with HF Questionnaire (MLwHFQ), and Depression through the Beck Depression Inventory (BDI) conducted before and after the interventions., Results: Thirty-eight patients (14 in CRT, 14 in CRT+MRT, and 10 in RUHB), with a mean age of 55 years and 50% male, completed the study. After 12 weeks, only the CRT group displayed a significant effect in certain ET variables VO2 peak [baseline 12 (9-15) vs post 16 (11-19) ml/kg/min, p<0.05], VO2peak (ml/min) [baseline 848 (640-1056) vs post 1103 (852-1355) p<0.05], VE/VCO2 slope [baseline 34 (27-41) vs post 31 (27-36) p<0.05] and VO2/HRpeak [baseline 7 (5-9) vs post 11 (8-14) p<0.05]. There were significant decreases in the ΔMLwHFQ in the CRT group vs. RUHB (p<0.001) and CRT+MRT group vs. RUHB (p<0.001), demonstrating improved quality of life after 12 weeks in CRT and CRT+MRT groups., Conclusion: Our findings suggest that CRT alone is sufficient to enhance cardiorespiratory function and muscle capacity, improve the quality of life, and alleviate depression in individuals with HF., Competing Interests: NO authors have competing interests., (Copyright: © 2024 Thomaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aims to (1) compare the kinetics of pulmonary oxygen uptake (VO2p), skeletal muscle deoxygenation ([HHb]), and microvascular O 2 delivery (QO 2 mv) between heart failure (HF) patients with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF), and (2) explore the correlation between body composition, kinetic parameters, and exercise performance. Twenty-one patients (10 HFpEF and 11 HFrEF) underwent cardiopulmonary exercise testing to assess VO 2 kinetics, with near-infrared spectroscopy (NIRS) employed to measure [HHb]. Microvascular O 2 delivery (QO 2 mv) was calculated using the Fick principle. Dual-energy X-ray absorptiometry (DEXA) was performed to evaluate body composition. HFrEF patients exhibited significantly slower VO 2 kinetics (time constant [t]: 63 ± 10.8 s vs. 45.4 ± 7.9 s; P < 0.05) and quicker [HHb] response (t: 12.4 ± 9.9 s vs. 25 ± 11.6 s; P < 0.05). Microvascular O2 delivery (QO 2 mv) was higher in HFrEF patients (3.6 ± 1.2 vs. 1.7 ± 0.8; P < 0.05), who also experienced shorter time to exercise intolerance (281.6 ± 84 s vs. 405.3 ± 96 s; P < 0.05). Correlation analyses revealed a significant negative relationship between time to exercise and both QO 2 mv (ρ= -0.51; P < 0.05) and VO2 kinetics (ρ= -0.63). Body adiposity was negatively correlated with [HHb] amplitude (ρ= -0.78) and peak VO 2 (ρ= -0.54), while a positive correlation was observed between lean muscle percentage, [HHb] amplitude, and tau (ρ= 0.74 and 0.57; P < 0.05), respectively. HFrEF patients demonstrate more severely impaired VO2p kinetics, skeletal muscle deoxygenation, and microvascular O 2 delivery compared to HFpEF patients, indicating compromised peripheral function. Additionally, increased adiposity and reduced lean mass are linked to decreased oxygen diffusion capacity and impaired oxygen uptake kinetics in HFrEF patients., (© 2024. The Author(s).)

Background: There is no definition for strain deformation values in relation to cardiorespiratory fitness (CRF) in different heart failure (HF) phenotypes., Aim: To identify the relationship between echocardiographic systolic function measurements and CRF in HF patients., Methods: Systematic review and meta-analysis following the PRISMA recommendations. Studies reporting echocardiographic assessments of left ventricular global longitudinal strain (LVGLS), left ventricular ejection fraction (LVEF), and direct measurement of peak oxygen uptake (VO 2peak ) in HF patients with reduced or preserved LVEF (HFrEF, HFpEF) were included. The patients were divided into Weber classes according to VO 2peak ., Results: A total of 25 studies involving of 2,136 patients (70.5% with HFpEF) were included. Mean LVEF and LVGLS were similar in HFpEF patients in Weber Class A/B and Class C/D. In HFrEF patients, a non-significant difference was found in LVEF between Weber Class A/B (30.2% [95%CI: 29.6 to 30.9%]) and Class C/D (25.2% [95%CI: 20.5 to 29.9%]). In HFrEF patients, mean LVGLS was significantly lower in Class C/D compared to Class A/B (6.5% [95%CI: 6.0 to 7.1%] and 10.3% [95%CI: 9.0 to 11.5%], respectively). The correlation between VO 2peak and LVGLS (r 2  = 0.245) was nearly twofold stronger than that between VO 2peak and LVEF (r 2  = 0.137)., Conclusions: Low LVGLS values were associated with low CRF in HFrEF patients. Although a weak correlation was found between systolic function at rest and CRF, the correlation between VO 2peak and LVGLS was nearly twofold stronger than that with LVEF, indicating that LVGLS may be a better predictor of CRF in patients with HFrEF., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose. There is no relationship with the industry., (Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)

Objectives: To analyze diaphragmatic thickness, at end-inspiration and end-expiration, diaphragmatic thickening index and mobility via US under two different modalities of inspiratory muscle loading, in two different modalities of inspiratory muscle loading and different load intensities at full-vital capacity maneuvers and the relationship between diaphragmatic thickness with pulmonary function tests in participants with HF., Methods: This randomized crossover trial, enrolled with 17 HF subjects, evaluated diaphragm thickness (Tdi, mm), fractional thickness (TFdi, %), and mobility (mm) US during low and high intensities (30% and 60% of maximal inspiratory pressure-MIP) with two modalities of inspiratory muscle loading mechanical threshold loading (MTL) and tapered flow-resistive loading (TFRL)., Results: Both MTL and TFRL produced a increase in Tdi, but only with high intensity loading compared to baseline-2.21 (0.26) vs. 2.68 (0.33) and 2.73 (0.44) mm; p = .01. TFdi was greater than baseline under all conditions, except during low intensity of TFRL. Diaphragm mobility was greater than baseline under all conditions, and high intensity of TFRL elicited greater mobility compared to all other conditions. Additionally, baseline Tdi was moderately correlated with pulmonary function tests., Conclusions: MTL and TFRL modalities elicit similar increases in diaphragm thickness at loads, but only during high intensity loading it was greater than baseline. Diaphragm mobility was significantly greater than baseline under both loads and devices, and at high intensity compared to low intensity, although TFRL produced greater mobility compared to modalities of inspiratory muscle loading. There is an association between diaphragm thickness and pulmonary function tests., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zacarias Rondinel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: Conflict of interest: None declared.

Background: Spirometry is underused in heart failure (HF) and the extent to which each defect associates with exercise capacity and prognosis is unclear., Objective: To determine the distinct relationship of continuous %predicted FVC (ppFVC) and FEV1/FVC with: 1) maximal inspiratory pressure (MIP), left ventricular ejection fraction (LVEF), exercise performance; and 2) prognosis for the composite of cardiovascular death, heart transplantation or left ventricular assist device implant., Methods: A cohort of 111 HF participants (AHA stages C/D) without diagnosed pneumopathy, spirometry, manovacuometry and maximum cardiopulmonary test. The association magnitudes were verified by linear and Cox (HR; 95% CI) regressions, age/sex adjusted. A p<0.05 was considered significant., Results: Age was 57±12 years, 60% men, 64% in NYHA III. Every 10%-point increase in FEV1/FVC [β 7% (95% CI: 3-10)] and ppFVC [4% (2-6)] associated with ventilatory reserve (VRes), however only ppFVC associated with MIP [3.8 cmH2O (0.3-7.3)], LVEF [2.1% (0.5-3.8)] and VO2peak [0.5 mL/kg/min (0.1-1.0)], accounting for age/sex. In 2.2 years (mean), 22 events occurred, and neither FEV1/FVC (HR 1.44; 95% CI: 0.97-2.13) nor ppFVC (HR 1.13; 0.89-1.43) was significantly associated with the outcome. Only in the LVEF ≤50% subgroup (n=87, 20 events), FEV1/FVC (HR 1.50; 1.01-2.23), but not ppFVC, was associated with greater risk., Conclusions: In chronic HF, reduced ppFVC associated with lower MIP, LVEF, VRes and VO2peak, but no distinct poorer prognosis over 2.2 years of follow-up. Distinctively, FEV1/FVC was associated only with VRes, and, in participants with LVEF ≤50%, FEV1/FVC reduction proportionally worsened prognosis. Therefore, FEV1/FVC and ppFVC add supplementary information regarding HF phenotyping.

Objective: The purposed of this study was to valuate the effect of osteopathic manipulative treatment (OMT) on flow-mediated dilation and heart rate variability of patients with heart failure., Background: Osteopathic manipulative treatment modulates both the vascular and autonomic nervous system (ANS) in healthy volunteers. However, the acute and time-course effects of the OMT on patients with an overactive ANS remain unclear., Methods: This randomized controlled trial study included 20 patients with heart failure aged 50 to 60 years, allocated to a single session of OMT (base of the skull, retromaxillary region, heart, and thoracic duct) or sham. Flow-mediated dilation (FMD) at the brachial artery, hemodynamic measures, and heart rate variability were assessed in 3 periods (baseline, immediately after the intervention, and after 15 minutes). Multivariate analysis of variance procedure was used to compare intervention and periods., Results: The OMT group had a greater FMD modulation compared with the sham (FMD,% =  9.5 vs. -5.6, 95% confidence interval (CI): [6.6, -12.35] vs. [-14.25, 2.8]; p = 0.001) and grater peak diameter (PD, mm =  0.77 vs -0.16 mm, 95% CI: [0.31,-1.24] vs [-0.63, 0.29]; P =  0.001), suggesting an important acute and time-course vascular effect from OMT. We also found some relevant heart rate variability modulation after 15 minutes from OMT: high frequency (HF, ms 2  = 295 vs -354, 95% CI: [144.2, -769]; P = .001) and low frequency (LF, ms 2 ) = 670 vs 775, 95% CI: [-98, 3591]; P = .001), suggesting a time-course ANS modulation after OMT., Conclusions: Osteopathic manipulative treatment was effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure. Moreover, vascular changes seem to precede the autonomic modulation., (Copyright © 2021. Published by Elsevier Inc.)

Objective: The purpose of this study was to analyze the reliability (interrater and intrarater) and agreement (repeatability and reproducibility) properties of tapered flow resistive loading (TFRL) measures in patients with heart failure (HF)., Methods: For this cross-sectional study, participants were recruited from the cardiopulmonary rehabilitation program at the University of Brasilia from July 2015 to July 2016. All patients participated in the study, and 10 were randomly chosen for intrarater and interrater reliability testing. The 124 participants with HF (75% men) were 57.6 (SD = 1.81) years old and had a mean left ventricular ejection fraction of 38.9% (SD = 15%) and a peak oxygen consumption of 13.05 (SD = 5.3) mL·kg·min-1. The main outcome measures were the maximal inspiratory pressure (MIP) measured with a standard manovacuometer (SM) and the MIP and maximal dynamic inspiratory pressure (S-Index) obtained with TFRL. The S-Index reliability (interrater and intrarater) was examined by 2 evaluators, the S-Index repeatability was examined with 10 repetitions, and the reproducibility of the MIP and S-Index was measured with SM and TFRL, respectively., Results: The reliability analysis revealed high S-Index interrater and intrarater reliability values (intraclass correlation coefficients [ICCs] of 0.89 [95% CI = 0.58-0.98] and 0.97 [95% CI = 0.89-0.99], respectively). Repeatability analyses revealed that 8 maneuvers were required to reach the maximum S-Index in 75.81% (95% CI = 68.27-83.34) of the population. The reproducibility of TFRL measures (S-Index = 68.8 [SD = 32.8] cm H2O; MIP = 66 [SD = 32.3] cm H2O) was slightly lower than that of the SM measurement (MIP = 70.1 [SD = 35.9] cm H2O)., Conclusions: The TFRL device provided a reliable intrarater and interrater S-Index measure in patients with HF and had acceptable repeatability, requiring 8 maneuvers to produce a stable S-Index measure. The reproducibilities of the S-Index, MIP obtained with SM, and MIP obtained with TRFL were similar., Impact: TRFL is a feasible method to assess both MIP and the S-index as measures of inspiratory muscle strength in patients with HF and can be used for inspiratory muscle training, making the combined testing and training capabilities important in both clinical research and the management of patients with HF., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)