Early Detection of Diastolic Dysfunction and the Role of Lifestyle Measures in Its Treatment

The project aims to investigate the effect of a regular exercise for 6 months on diastolic parameters in patients who present with shortness of breath and who have evidence of early diastolic dysfunction on echocardiography. Patients will be enrolled from the VA General Medicine and Cardiology Clinics, and will be screened for diastolic dysfunction. Once enrolled, they will be on an exercise regimen that involves aerobic exercise for 30-45 minutes five times a week at home. The participants will have an initial supervised exercise session with the VA Cardiac Rehabilitation team, and will have either every other week or monthly supervised sessions at the VA Cardiac Rehabilitation Center to monitor their progress. Clinical, biometric, laboratory and echocardiographic parameters will be obtained before and after the 6 month period.

Study Overview

• Status: Completed
• Conditions: Diastolic Dysfunction
• Intervention / Treatment: Behavioral: Exercise

Detailed Description

Introduction:

Diastolic dysfunction (DD) accounts for >50% of all heart failure (DHF) hospitalizations and this number is increasing with age, obesity and diabetes.

There are no proven treatments for DHF apart from blood pressure control.

Aim:

If diagnosed early, is this reversible with lifestyle changes; namely, aerobic exercise and weight reduction?

Methods:

We will screen veterans presenting to the medicine, cardiology and pulmonary services with dyspnea. We will perform echocardiography with Doppler which non-invasively measures cardiac filling and diastolic dysfunction. Treadmill exercise echo will be performed to quantify DD.

Bruce treadmill protocol description/ procedure: Exercise is performed on a treadmill. The test starts at 2.74 km/hr (1.7 mph) and at a gradient (or incline) of 10%. At three minute intervals the incline of the treadmill increases by 2%, and the speed increases as shown in the table below.

Stage Speed (mph) Gradient:

1. 1.7 10
2. 2.5 12
3. 3.4 14
4. 4.2 16
5. 5.0 18
6. 5.5 20
7. 6.0 22
8. 6.5 24
9. 7.0 26
10. 7.5 28

Subject exercise study:

For physical exercise to have a beneficial effect on cardiac function, we suggest the following:

• Type of Exercise
• Walking - outdoors or treadmill
• Running or jogging
• Cycling - outdoors or stationary

Duration of Exercise:

Initial 2-3 minute gradual warm-up period. Roughly 30 minutes of continuous exercise 5 times a week.

Finally a few minutes of gradual cool-down before terminating exercise.

Intensity of Exercise:

Target exercise at a "moderately significant exertion".

We will demonstrate what is adequate in the beginning and periodically throughout the 6 months of the study.

"Maximum age predicted heart rate (MPHR)" is calculated as 220 minus subject's age. Then we would like to sustain roughly about 70 to 85% of MPHR for 25-30 minutes.

"Successful" Exerciser: Subjects who are able to adhere to the required intensity and duration of exercise for the majority (about 75% or more) of the time; averaging 150 minutes/ week on self reporting.

• Study Type: Interventional
• Enrollment (Actual): 9
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • Columbia, Missouri, United States, 65201
      • Harry S Truman Veterans Administration Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients with dyspnea/shortness of breath
• Age 40-65 years of age
• Sedentary lifestyle (<150 minutes of exercise/week)
• Echocardiographic evidence of early diastolic dysfunction: mitral E/A <0.9, OR resting E/E' between 8-15 cm/s, OR post-exercise E/E' >13 cm/s.

Exclusion criteria:

• Age <40 years or >65 years
• Coronary Artery Disease by angiography or evidence of ischemia on a stress test
• Systolic Dysfunction (LV Ejection fraction <50%)
• Congestive Heart Failure Functional Class III or IV
• Moderate to severe COPD (FEV <80% predicted)
• Moderate to severe valvular heart disease, except tricuspid regurgitation
• Inability to get heart rate >/= 85% of maximum predicted heart rate
• Uncontrolled hypertension (systolic BP>140mmHg, diastolic BP>90mmHg) despite medical therapy
• On echocardiogram, RV systolic pressure >60mmHg that suggests severe pulmonary hypertension
• On echocardiogram, left atrial size> 6.5 cm or left atrial volume > 35 ml/BSA

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Exercise and diastolic dysfunction; Aerobic exercise for 30-45 minutes five times a week for six months	Behavioral: Exercise; Aerobic exercise for 30-45 minutes five times a week for six months; Other Names: Diastolic Dysfunction

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Exercise echo Doppler will be done at baseline and after completion of 6 months of an exercise program	Beginning of study participation and after 6 months of study participation

Collaborators and Investigators

• Sponsor: University of Missouri-Columbia
• Investigators: Principal Investigator: Anand Chockalingam, MD, University of Missouri/Harry S Truman VA Hospital

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): May 1, 2010
• Study Completion (Actual): May 1, 2011

Study Registration Dates

• First Submitted: October 19, 2009
• First Submitted That Met QC Criteria: October 19, 2009
• First Posted (Estimate): October 20, 2009

Study Record Updates

• Last Update Posted (Estimate): October 5, 2016
• Last Update Submitted That Met QC Criteria: October 3, 2016
• Last Verified: October 1, 2016

More Information

Terms related to this study

• Keywords: Aerobic Exercise; Weight Reduction; Early Cardiac Diastolic Dysfunction
• Other Study ID Numbers: 1115737

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No