Functional Electrical Stimulation is More Effective in Severe Symptomatic Heart Failure Patients and Improves Their Adherence to Rehabilitation Programs

Karavidas, Apostolos; Parissis, John T.; Matzaraki, Vassiliki; Arapi, Sophia; Varounis, Christos; Ikonomidis, Ignatios; Grillias, Panagiotis; Paraskevaidis, Ioannis; Pirgakis, Vlassios; Filippatos, Gerasimos; Kremastinos, Dimitios T.

doi:10.1016/j.cardfail.2009.10.023

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 244-249, March 2010

Functional Electrical Stimulation is More Effective in Severe Symptomatic Heart Failure Patients and Improves Their Adherence to Rehabilitation Programs

Apostolos Karavidas, MD
- Cardiology Department, General Hospital “G.Genimmatas”, Athens, Greece
John T. Parissis, MD
- Second Cardiology Department and Heart Failure Unit, Attikon University Hospital, Athens, Greece
- Reprint requests: John T Parissis, MD, Heart Failure Clinic, Attikon University Hospital, University of Athens, Athens, Greece. Tel: +30210-6123720; Fax: +30210-5832195.
Vassiliki Matzaraki, MD
- Cardiology Department, General Hospital “G.Genimmatas”, Athens, Greece
Sophia Arapi, MD
- Cardiology Department, General Hospital “G.Genimmatas”, Athens, Greece
Christos Varounis, MD
- Second Cardiology Department and Heart Failure Unit, Attikon University Hospital, Athens, Greece
Ignatios Ikonomidis, MD
- Second Cardiology Department and Heart Failure Unit, Attikon University Hospital, Athens, Greece
Panagiotis Grillias, PT
- Cardiology Department, General Hospital “G.Genimmatas”, Athens, Greece
Ioannis Paraskevaidis, MD
- Second Cardiology Department and Heart Failure Unit, Attikon University Hospital, Athens, Greece
Vlassios Pirgakis, MD
- Cardiology Department, General Hospital “G.Genimmatas”, Athens, Greece
Gerasimos Filippatos, MD
- Second Cardiology Department and Heart Failure Unit, Attikon University Hospital, Athens, Greece
Dimitios T. Kremastinos, MD
- Second Cardiology Department and Heart Failure Unit, Attikon University Hospital, Athens, Greece

Received 17 July 2009; received in revised form 17 October 2009; accepted 21 October 2009. published online 11 December 2009.

Abstract

Background

Functional electrical stimulation (FES) improves exercise capacity and quality of life in chronic heart failure (CHF) patients. However, there is no evidence regarding the effectiveness of this treatment modality according to the severity of CHF. This study compares the effectiveness of FES on exercise capacity, endothelial function, neurohormonal status, and emotional stress in New York Heart Association (NYHA) III-IV versus NYHA II patients.

Methods and Results

Eighteen NYHA II and 13 age- and sex-matched NYHA III-IV patients with stable CHF (left ventricular ejection fraction <35%) underwent a 6-week FES training program. Questionnaires addressing quality of life (Kansas City Cardiomyopathy Questionnaire, functional and overall), and emotional stress (Zung self-rating depression scale, Beck Depression Inventory), as well as plasma B-type natriuretic peptide (BNP), 6-minute walking distance test (6MWT), and endothelial function (flow-mediated dilatation [FMD]) were assessed at baseline and after completion of training protocol. 6MWT and plasma BNP improved significantly in 2 patient groups (both P < .001) after training program. The improvement of BNP was statistically greater in NYHA III-IV patients posttreatment than in those with NYHA II class (F=315.342, P < .001). Similarly, the improvement of 6MWT was statistically greater in NYHA III-IV group than in NYHA II patients (F=79.818, P < .001). Finally, an FES-induced greater improvement of FMD (F=9.517, P=.004) and emotional stress scores was observed in NYHA III-IV patients in comparison to NYHA II patients. There was a higher proportion of NYHA III-IV patients adhering to the FES training program for additional 3 months compared with the NYHA II group of patients (76.9% vs. 55.6%, P < .001).

Conclusion

FES might exert a greater beneficial effect on clinical and neurohormonal status of NYHA III-IV patients in comparison to NYHA II patients. This effect may have important clinical relevance leading to increased adherence of severe CHF patients to exercise rehabilitation programs.

Key Words: Exercise training, chronic heart failure, effectiveness, functional status, adherence