Amir Zaghi – Institutionen för kliniska vetenskaper, Malmö

Title: Physical activity, cardiovascular function and prognosis in heart failure

Main supervisor: Professor Martin Magnusson

Reviewers: Professor Magnus Dencker, PhD Per Arvidsson

Abstract

Background

Heart failure remains a leading cause of hospitalization and mortality despite advances in pharmacological treatment. Physical activity has been consistently associated with improved prognosis, but the underlying mechanisms are not fully understood. The current project investigates how physical activity relates to outcomes and intermediate markers such as cardiac function, cerebral oxygenation, and biomarkers.

Research questions

1. What is the association between physical activity and the risks of mortality and rehospitalization in patients with heart failure?
2. Is physical activity related to cerebral oxygenation, assessed by near- infrared spectroscopy (SctO₂), and does SctO₂ have prognostic value in heart failure?
3. How is objectively measured physical activity (accelerometry) associated with echocardiographic parameters and ECG-derived P- wave indices in the general population, and do these alterations indicate early susceptibility to heart failure or arrhythmias?
4. Is physical activity linked to circulating biomarkers of cardiac stress, renal function, and systemic inflammation in a population-based cohort, and do these biomarkers act as intermediate mechanisms between activity and cardiovascular outcomes?

Preliminary results

Analyses from the HARVEST cohort demonstrate that higher levels of self- reported physical activity, assessed with a validated questionnaire from the Swedish Public Health Agency, are associated with lower mortality and fewer rehospitalizations in patients with heart failure. Moreover, cerebral oxygen saturation (SctO₂), measured by near-infrared spectroscopy, was independently associated with all-cause mortality but not with risk of first rehospitalization. Physical inactivity was further linked to lower SctO₂ at rest, suggesting impaired cerebral oxygenation in less active hear failure patients.

Significance

By integrating clinical outcomes, physiological measurements, and biomarker profiling, this project seeks to provide an understanding of the role of physical activity in heart failure. The findings have the potential to refine risk stratification, illuminate biological mechanisms linking lifestyle to disease progression, and inform preventive and therapeutic strategies in both patients with established HF and the general population.

Published and ongoing studies

One manuscript on physical activity and prognosis in HARVEST has been published, while a second manuscript on cerebral oxygenation and physical activity is currently under review in Heart. Planned analyses include accelerometry and echocardiography in SCAPIS, as well as biomarker associations in SCAPIS.

Reference

Zaghi A, Holm H, Korduner J, Dieden A, Molvin J, Bachus E, Jujic A, and Magnusson M (2022). Physical inactivity is associated with post-discharge mortality and re-hospitalization risk among Swedish heart failure patients – The HARVEST-Malmö Study. Front. Cardiovasc. Med. 9:843029. doi: 10.3389/fcvm.2022.843029