Impact of cardiac rehabilitation on functional and metabolic outcomes in patients with preserved and non-preserved left ventricular ejection fraction
B Rocha, C O Ferreira, J Faria, F Vilela, M Dias, S Fernandes, I Conde, C Oliveira, C Braga, J MarquesAbstract
Abstract
Introduction and Objectives: Cardiac rehabilitation (CR) is a cornerstone of secondary prevention in cardiovascular disease, combining exercise training, risk factor optimisation, and patient education to improve prognosis and quality of life. In heart failure, CR enhances exercise tolerance and promotes better control of modifiable risk factors. Differences in cardiac function and comorbidity profiles between patients with preserved and non-preserved left ventricular ejection fraction (LVEF) may influence their response to rehabilitation. This study aimed to assess the effects of a phase II CR programme in patients with non-preserved LVEF and to compare changes in cardiovascular risk factors, chronotropic response, and functional capacity with those observed in patients with preserved LVEF.
Methods
A retrospective study was conducted including patients with ischaemic or non-ischaemic heart disease referred for CR between June 2017 and March 2025. Participants were stratified according to baseline LVEF into preserved (≥50%) and non-preserved (<50%) groups. Clinical and laboratory assessments were performed at the first and final CR consultations, including body mass index (BMI), lipid profile, chronotropic index, and functional capacity derived from exercise testing.
Results
A total of 124 patients were included, 69 with preserved and 55 with non-preserved LVEF. Patients with non-preserved LVEF were more frequently hypertensive, exhibited higher NYHA class and BNP levels, and had lower baseline functional capacity. After completion of the phase II CR programme, both groups showed a statistically significant improvement in functional capacity and a reduction in LDL cholesterol. A significant increase in the chronotropic index was observed in patients with preserved LVEF, whereas no significant change occurred in those with non-preserved LVEF. However, no significant differences were found between groups in the magnitude of overall improvements.
Conclusion
Phase II cardiac rehabilitation produced significant improvements in exercise capacity and LDL cholesterol in both preserved and reduced LVEF groups. Despite a less favourable baseline profile, patients with reduced LVEF achieved functional gains comparable to those with preserved LVEF, underscoring the value of CR in this high-risk population. These results reinforce cardiac rehabilitation for all eligible patients, while highlighting the need to tailor programme delivery for the high-risk reduced-LVEF subgroup.