Heterogeneous metabolic response to exercise training in heart failure with preserved ejection fraction

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

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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 (ISRCTN86879094). 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 di erences between ET and UC from baseline to follow-up were compared and di erential 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.

Original languageEnglish
Article number591
JournalJournal of Clinical Medicine
Volume8
Issue number5
DOIs
StatePublished - May 2019

Keywords

  • Exercise
  • Heart failure with preserved ejection fraction
  • Metabolomics

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