Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction
The prevalence of heart failure with preserved ejection fraction (HFpEF) is constantly increasing and no evidence-based pharmacological treatment option is available. While exercise training (ET) improves diastolic function, its metabolic mechanisms in HFpEF are unclear. We assessed the metabolic re...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2019-04-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/8/5/591 |
| _version_ | 1797417414509461504 |
|---|---|
| author | Martin Bahls Nele Friedrich Maik Pietzner Rolf Wachter Kathrin Budde Gerd Hasenfuß Matthias Nauck Axel Pressler Stephan B. Felix Frank Edelmann Martin Halle Marcus Dörr |
| author_facet | Martin Bahls Nele Friedrich Maik Pietzner Rolf Wachter Kathrin Budde Gerd Hasenfuß Matthias Nauck Axel Pressler Stephan B. Felix Frank Edelmann Martin Halle Marcus Dörr |
| author_sort | Martin Bahls |
| collection | DOAJ |
| description | The prevalence of heart failure with preserved ejection fraction (HFpEF) is constantly increasing and no evidence-based pharmacological treatment option is available. While exercise training (ET) improves diastolic function, its metabolic mechanisms in HFpEF are unclear. We assessed the metabolic response to 12 weeks of ET in patients with HFpEF by performing a post hoc analysis of the EX-DHF-P trial (ISRCTN42524037). Plasma concentrations of 188 endogenous metabolites were measured in 44 ET and 20 usual care (UC) patients at baseline and 3-months follow-up. Metabolic differences between ET and UC from baseline to follow-up were compared and differential responses to ET were examined by random forest feature selection. ET prevented the increase of acetylornithine and carnitine as well as the decrease of three glycerophospholipids. After ET, two opposite metabolic response clusters were identified. Cluster belonging was associated with perceived well-being at baseline and changes in low-density lipoprotein but not with cardiorespiratory, ventilatory or echocardiographic parameters. These two ET-induced metabolic response patterns illustrate the heterogeneity of the HFpEF patient population. Our results suggest that other biological parameters might be helpful besides clinical variables to improve HFpEF patient stratification. Whether this approach improves response prediction regarding ET and other treatments should be explored. |
| first_indexed | 2024-03-09T06:18:26Z |
| format | Article |
| id | doaj.art-0986437786a34ed4850cdb9d323906f8 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T06:18:26Z |
| publishDate | 2019-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0986437786a34ed4850cdb9d323906f82023-12-03T11:49:55ZengMDPI AGJournal of Clinical Medicine2077-03832019-04-018559110.3390/jcm8050591jcm8050591Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection FractionMartin Bahls0Nele Friedrich1Maik Pietzner2Rolf Wachter3Kathrin Budde4Gerd Hasenfuß5Matthias Nauck6Axel Pressler7Stephan B. Felix8Frank Edelmann9Martin Halle10Marcus Dörr11Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, GermanyDZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, GermanyDZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, GermanyDepartment of Cardiology, University of Göttingen, 37099 Göttingen, GermanyDZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, GermanyDepartment of Cardiology, University of Göttingen, 37099 Göttingen, GermanyDZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, GermanyDepartment of Prevention, Rehabilitation and Sports Medicine, Technical University Munich, 80992 Munich, GermanyDepartment of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, GermanyDepartment of Internal Medicine and Cardiology, Charité University Hospital (Campus Virchow Klinikum), 13353 Berlin, GermanyDepartment of Prevention, Rehabilitation and Sports Medicine, Technical University Munich, 80992 Munich, GermanyDepartment of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, GermanyThe prevalence of heart failure with preserved ejection fraction (HFpEF) is constantly increasing and no evidence-based pharmacological treatment option is available. While exercise training (ET) improves diastolic function, its metabolic mechanisms in HFpEF are unclear. We assessed the metabolic response to 12 weeks of ET in patients with HFpEF by performing a post hoc analysis of the EX-DHF-P trial (ISRCTN42524037). Plasma concentrations of 188 endogenous metabolites were measured in 44 ET and 20 usual care (UC) patients at baseline and 3-months follow-up. Metabolic differences between ET and UC from baseline to follow-up were compared and differential responses to ET were examined by random forest feature selection. ET prevented the increase of acetylornithine and carnitine as well as the decrease of three glycerophospholipids. After ET, two opposite metabolic response clusters were identified. Cluster belonging was associated with perceived well-being at baseline and changes in low-density lipoprotein but not with cardiorespiratory, ventilatory or echocardiographic parameters. These two ET-induced metabolic response patterns illustrate the heterogeneity of the HFpEF patient population. Our results suggest that other biological parameters might be helpful besides clinical variables to improve HFpEF patient stratification. Whether this approach improves response prediction regarding ET and other treatments should be explored.https://www.mdpi.com/2077-0383/8/5/591exerciseheart failure with preserved ejection fractionmetabolomics |
| spellingShingle | Martin Bahls Nele Friedrich Maik Pietzner Rolf Wachter Kathrin Budde Gerd Hasenfuß Matthias Nauck Axel Pressler Stephan B. Felix Frank Edelmann Martin Halle Marcus Dörr Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction Journal of Clinical Medicine exercise heart failure with preserved ejection fraction metabolomics |
| title | Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction |
| title_full | Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction |
| title_fullStr | Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction |
| title_full_unstemmed | Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction |
| title_short | Heterogeneous Metabolic Response to Exercise Training in Heart Failure with Preserved Ejection Fraction |
| title_sort | heterogeneous metabolic response to exercise training in heart failure with preserved ejection fraction |
| topic | exercise heart failure with preserved ejection fraction metabolomics |
| url | https://www.mdpi.com/2077-0383/8/5/591 |
| work_keys_str_mv | AT martinbahls heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT nelefriedrich heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT maikpietzner heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT rolfwachter heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT kathrinbudde heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT gerdhasenfuß heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT matthiasnauck heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT axelpressler heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT stephanbfelix heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT frankedelmann heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT martinhalle heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction AT marcusdorr heterogeneousmetabolicresponsetoexercisetraininginheartfailurewithpreservedejectionfraction |