The molecular response to exercise training in patients with heart failure with preserved ejection fraction

The incidence and prevalence of heart failure with preserved ejection fraction (HFpEF) is continuously increasing and expected to rise further [1]. All randomized clinical trials exploring pharmacological treatment options have been unsuccessful [2, 3]. However, structured exercise training has not just shown to improve diastolic function but also cardiorespiratory exercise capacity [4]. However, the response to exercise training is not homogenous. Some individuals respond very fast and show beneficial effects as well as improve their prognosis. Unfortunately, other patients need a longer time to respond. This delayed response most likely has adverse effects on long term adaptation of an active lifestyle. Hence, a better understanding of the molecular response to exercise training is essential to allow for individualized exercise recommendations in the future. In this project we aim to characterize the molecular adaption to exercise training in the largest exercise trial in patients with HFpEF to date [5]. In the "exercise training in diastolic heart failure" (EX-DHF) a total of 322 patients were randomized either to structured exercise training or control group for twelve months. Here we plan to characterize the cardiovascular response response to exercise training by evaluating 92 protein biomarkers of the Target 96 panel CVDII (Olink Proteomics, Uppsala, Sweden). Blood samples are available for three time points (baseline, 3 months and 12 months). With the data obtained from this project we will be able to identify different subgroups of exercise responders.