A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure

Bandi Hari Krishna, Pravati Pal, Gk Pal, J Balachander, E Jayasettiaseelon, Y Sreekanth, Mg Sridhar, Gs Gaur, Bandi Hari Krishna, Pravati Pal, Gk Pal, J Balachander, E Jayasettiaseelon, Y Sreekanth, Mg Sridhar, Gs Gaur

Abstract

Aims: The purpose of this study was to evaluate whether yoga training in addition to standard medical therapy can improve cardiac function and reduce N terminal pro B-type natriuretic peptide (NT pro BNP) in heart failure (HF).

Methods: 130 patients were recruited and randomized into two groups: Control Group (CG) (n = 65), Yoga Group (YG). In YG, 44 patients and in CG, 48 patients completed the study. Cardiac function using left ventricular ejection fraction (LVEF), myocardial performance index (Tei index), and NT pro BNP, a biomarker of HF, was assessed at baseline and after 12 weeks.

Result: Improvement in LVEF, Tei index, and NT pro BNP were statistically significant in both the groups. Furthermore, when the changes in before and after 12 weeks were in percentage, LVEF increased 36.88% in the YG and 16.9% in the CG, Tei index was reduced 27.87% in the YG and 2.79% in the CG, NT pro BNP was reduced 63.75% in the YG and 10.77% in the CG. The between group comparisons from pre to post 12 weeks were significant for YG improvements (LVEF, P < 0.01, Tei index, P < 0.01, NT pro BNP, P < 0.01).

Conclusion: These results indicate that the addition of yoga therapy to standard medical therapy for HF patients has a markedly better effect on cardiac function and reduced myocardial stress measured using NT pro BNP in patients with stable HF.

Keywords: NT pro BNP; Tei index; ejection fraction; heart failure; yoga therapy.

Figures

Figure 1
Figure 1
Schema for measurements of Doppler time intervals (according to Tei et al.18). The index (ICT + IRT/ET) is derived as (a − b/b), where a is the interval between cessation and onset of the mitral inflow, and b is the ejection time (ET) of left ventricular (LV) outflow. Isovolumetric relaxation time (IRT) is measured by subtracting the interval c between the R wave (ECG) and the cessation of LV outflow from the interval d between the R wave and the onset of mitral inflow (according to Kleinet al.19) Isovolumetric contraction time (ICT) is derived by subtracting IRT from a − b. ECG: electrocardiogram.
Figure 2
Figure 2
Scatter graph showing the correlation between change in LVEF and NT pro BNP in YG (r = −0.407).
Figure 3
Figure 3
Scatter graph showing the correlation between change in Tei index and NT pro BNP in YG (r = 0.132).
Figure 4
Figure 4
Flow chart of study recruitment.

References

    1. Adams KF, Jr, Zannad F. Clinical definition and epidemiology of advanced heart failure. Am Heart J. 1998;135:S204–S215.
    1. Masoudi FA, Baillie CA, Wang Y, et al. The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998–2001. Arch Intern Med. 2005;165:2069–76.
    1. Wilson JR, Ferraro N. Exercise intolerance in patients with chronic left heart failure: relation to oxygen transport and ventilatory abnormalities. Am J Cardiol. 1983;51:1358–63.
    1. Bruch C, Schmermund A, Marin D, et al. Tei-index in patients with mild-to-moderate congestive heart failure. Eur Heart J. 2000;21:1888–95.
    1. Belagavi AC, Rao M, Pillai AY, Srihari US. Correlation between NT proBNP and left ventricular ejection fraction in elderly patients presenting to emergency department with dyspnoea. Indian Heart J. 2012;64:302–4.
    1. Palazzuoli A, Gallotta M, Quatrini I, Nuti R. Natriuretic peptides (BNP and NT-proBNP): measurement and relevance in heart failure. Vasc Health Risk Manag. 2010;6:411–8.
    1. Lee SC, Stevens TL, Sandberg SM, et al. The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure. J Card Fail. 2002;8:149–54.
    1. Walke LM, Byers AL, Gallo WT, Endrass J, Fried TR. The association of symptoms with health outcomes in chronically ill adults. J Pain Symptom Manage. 2007;33:58–66.
    1. Bulavin VV, Kliuzhev VM, Kliachkin LM, Lakshmankumar, Zuikhin ND, Vlasova TN, et al. Elements of yoga therapy in the combined rehabilitation of myocardial infarct patients in the functional recovery period. Vopr Kurortol Fizioter Lech Fiz Kult. 1993:7–9.
    1. Pullen PR, Nagamia SH, Mehta PK, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008;14:407–13.
    1. Mahajan AS, Reddy KS, Sachdeva U. Lipid profile of coronary risk subjects following yogic lifestyle intervention. Indian Heart J. 1999;51:37–40.
    1. Selvamurthy W, Sridharan K, Ray US, et al. A new physiological approach to control essential hypertension. Indian J Physiol Pharmacol. 1998;42:205–13.
    1. Ornish D. Can lifestyle changes reverse coronary heart disease? World Rev Nutr Diet. 1993;72:38–48.
    1. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of hatha yoga practice on the health-related aspects of physical fitness. Prev Cardiol. 2001;4:165–70.
    1. Paul Biman Bihari. Effect of shavasan practices on coronary heart patients with special reference to shavasan and meditation. Int Sci Yoga J Sense. 2011;1:86–91.
    1. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American society of echocardiography committee on standards, subcommittee on quantitation of two-dimensional echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.
    1. Quinones MA, Waggoner AD, Reduto LA, et al. A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation. 1981;64:744–53.
    1. Tei C, Ling LH, Hodge DO, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26:357–66.
    1. Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB, et al. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc. 1994;69:212–24.
    1. Cohn JN. The management of chronic heart failure. N Engl J Med. 1996;335:490–8.
    1. Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol. 1995;26:135–6.
    1. Pullen PR, Thompson WR, Benardot D, et al. Benefits of yoga for African American heart failure patients. Med Sci Sports Exerc. 2010;42:651–7.
    1. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of hatha yoga practice on the health-related aspects of physical fitness. Prev Cardiol. 2001;4:165–70.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe