***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The heart failure ( HF ) syndrome is heterogeneous . While it can be defined by ejection fraction ( EF ) and diastolic function , data on the characteristics of HF in the community are scarce , as most studies are retrospective , hospital-based , and rely on clinical ly indicated tests . Further , diastolic function is seldom systematic ally assessed based on st and ardized techniques . OBJECTIVE To prospect ively measure EF , diastolic function , and brain natriuretic peptide ( BNP ) in community residents with HF . MAIN OUTCOME MEASURES Echocardiographic measures of EF and diastolic function , measurement of blood levels of BNP , and 6-month mortality . DESIGN , SETTING , AND PARTICIPANTS Olmsted County residents with incident or prevalent HF ( in patients or out patients ) between September 10 , 2003 , and October 27 , 2005 , were prospect ively recruited to undergo assessment of EF and diastolic function by echocardiography and measurement of BNP . RESULTS A total of 556 study participants underwent echocardiography at HF diagnosis .  Preserved EF ( > or = 50 % ) was present in 308 ( 55 % ) and was associated with older age , female sex , and no history of myocardial infa rct ion ( all P<.001 ) . Isolated diastolic dysfunction ( diastolic dysfunction with preserved EF ) was present in 242 ( 44 % ) patients . For patients with reduced EF , moderate or severe diastolic dysfunction was more common than when EF was preserved ( odds ratio , 1.67 ; 95 % confidence interval [ CI ] , 1.11 - 2.51 ; P = .01 ) . Both low EF and diastolic dysfunction were independently related to higher levels of BNP . At 6 months , mortality was 16 % for both preserved and reduced EF ( age- and sex-adjusted hazard ratio , 0.85 ; 95 % CI , 0.61 - 1.19 ; P = .33 for preserved vs reduced EF ) . CONCLUSIONS In the community , more than half of patients with HF have preserved EF , and isolated diastolic dysfunction is present in more than 40 % of cases . Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP . Heart failure with preserved EF is associated with a high mortality rate , comparable to that of patients with reduced EF Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials Background Heart failure with preserved ejection fraction ( HFpEF ) is remarkably common in elderly people with highly prevalent comorbid conditions . Despite its increasing in prevalence , there is no evidence -based effective therapy for HFpEF . We sought to evaluate whether inspiratory muscle training ( IMT ) improves exercise capacity , as well as left ventricular diastolic function , biomarker profile and quality of life ( QoL ) in patients with advanced HFpEF and nonreduced maximal inspiratory pressure ( MIP ) . Design and methods A total of 26 patients with HFpEF ( median ( interquartile range ) age , peak exercise oxygen uptake ( peak VO2 ) and left ventricular ejection fraction of 73 years ( 66–76 ) , 10 ml/min/kg ( 7.6–10.5 ) and 72 % ( 65–77 ) , respectively ) were r and omized to receive a 12-week programme of IMT plus st and ard care vs. st and ard care alone . The primary endpoint of the study was evaluated by positive changes in cardiopulmonary exercise parameters and distance walked in 6 minutes ( 6MWT ) . Secondary endpoints were changes in QoL , echocardiogram parameters of diastolic function , and prognostic biomarkers . Results The IMT group improved significantly their MIP ( p < 0.001 ) , peak VO2 ( p < 0.001 ) , exercise oxygen uptake at anaerobic threshold ( p = 0.001 ) , ventilatory efficiency ( p = 0.007 ) , metabolic equivalents ( p < 0,001 ) , 6MWT ( p < 0.001 ) , and QoL ( p = 0.037 ) as compared to the control group . No changes on diastolic function parameters or biomarkers levels were observed between both groups . Conclusions In HFpEF patients with low aerobic capacity and non-reduced MIP , IMT was associated with marked improvement in exercise capacity and OBJECTIVES We sought to determine whether structured exercise training ( ET ) improves maximal exercise capacity , left ventricular diastolic function , and quality of life ( QoL ) in patients with heart failure with preserved ejection fraction ( HFpEF ) . BACKGROUND Nearly one-half of patients with heart failure experience HFpEF , but effective therapeutic strategies are sparse . METHODS A total of 64 patients ( age 65 ± 7 years , 56 % female ) with HFpEF were prospect ively r and omized ( 2:1 ) to supervised endurance/resistance training in addition to usual care ( ET , n = 44 ) or to usual care alone ( UC ) ( n = 20 ) . The primary endpoint was the change in peak Vo(2 ) after 3 months . Secondary endpoints included effects on cardiac structure , diastolic function , and QoL. RESULTS Peak Vo(2 ) increased ( 16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg ; p < 0.001 ) with ET and remained unchanged ( 16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg ; p = NS ) with UC . The mean benefit of ET was 3.3 ml/min/kg ( 95 % confidence interval [ CI ] : 1.8 to 4.8 , p < 0.001 ) . E/e ' ( mean difference of changes : -3.2 , 95 % CI : -4.3 to -2.1 , p < 0.001 ) and left atrial volume index ( milliliters per square meter ) decreased with ET and remained unchanged with UC ( -4.0 , 95 % CI : -5.9 to -2.2 , p < 0.001 ) . The physical functioning score ( 36-Item Short-Form Health Survey ) improved with ET and remained unchanged with UC ( 15 , 95 % CI : 7 to 24 , p < 0.001 ) . The ET-induced decrease of E/e ' was associated with 38 % gain in peak Vo(2 ) and 50 % of the improvement in physical functioning score . CONCLUSIONS Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF . This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function . ( Exercise Training in Diastolic Heart Failure-Pilot Study : A Prospect i ve , R and omised , Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [ Ex-DHF-P ] ; IS RCT N42524037 ) To determine the reliability and validity of a patient outcome question naire for chronic heart failure , a r and omized , double-blind , placebo-controlled , 3-month trial of pimobendan , an investigational medication with inotropic and vasodilator activities , was performed . Evaluated were 198 ambulatory patients with primarily New York Heart Association ( NYHA ) class III heart failure from 20 referral centers . Baseline therapy included digoxin , diuretics and , in 80 % , a converting enzyme inhibitor . Oral pimobendan at 2.5 ( n = 49 ) , 5.0 ( n = 51 ) , or 10 ( n = 49 ) mg daily or matching placebo ( n = 49 ) was administered . The Minnesota Living with Heart Failure ( LIhFE ) question naire was a primary outcome measure , along with an exercise test . Interitem correlations identified subgroups of questions representing physical and emotional dimensions . Repeated baseline scores were highly correlated ( r = 0.93 ) , as were the physical ( r = 0.89 ) and emotional ( r = 0.88 ) dimension scores . Placebo did not have a significant effect with median ( 25th , 75th percentile ) changes from baseline scores of 1 ( -3 , 5 ) , 1 ( -2 , 3 ) , and 0 ( -1 , 2 ) , respectively ( all p values greater than 0.10 ) . The 5 mg dose significantly improved the total score , 7.5 ( 0 , 18 ; p = 0.01 ) and the physical dimension , 4 ( 0 , 8 ; p = 0.01 ) , compared with placebo . Changes in the total ( r = 0.33 ; p less than 0.01 ) and physical ( r = 0.35 ; p less than 0.01 ) scores were weakly related to changes in exercise times , but corresponded well with changes in patients ' ratings of dyspnea and fatigue . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES The aim of this study was to analyze whether L-arginine ( L-arg . ) has comparable or additive effects to physical exercise regarding endothelium-dependent vasodilation in patients with chronic heart failure ( CHF ) . BACKGROUND Endothelial dysfunction in patients with CHF can be corrected by both dietary supplementation with L-arg . and regular physical exercise . METHODS Forty patients with severe CHF ( left ventricular ejection fraction 19 + /- 9 % ) were r and omized to an L-arg . group ( 8 g/day ) , a training group ( T ) with daily h and grip training , L-arg . and T ( L-arg . + T ) or an inactive control group ( C ) . The mean internal radial artery diameter was determined at the beginning and after four weeks in response to brachial arterial administration of acetylcholine ( ACh ) ( 7.5 , 15 , 30 microg/min ) and nitroglycerin ( 0.2 mg/min ) with a transcutaneous high-resolution 10 MHz A-mode echo tracking system coupled with a Doppler device . The power of the study to detect clinical ly significant differences in endothelium-dependent vasodilation was 96.6 % . RESULTS At the beginning , the mean endothelium-dependent vasodilation in response to ACh , 30 microg/min was 2.54 + /- 0.09 % ( p = NS between groups ) . After four weeks , internal radial artery diameter increased by 8.8 + /- 0.9 % after ACh 30 microg/min in L-arg . ( p < 0.001 vs. C ) , by 8.6 + /- 0.9 % in T ( p < 0.001 vs. C ) and by 12.0 + /- 0.3 % in L-arg . + /- T ( p < 0.005 vs. C , L-arg . and T ) . Endothelium-independent vasodilation as assessed by infusion of nitroglycerin was similar in all groups at the beginning and at the end of the study . CONCLUSIONS Dietary supplementation of L-arg . as well as regular physical exercise improved agonist-mediated , endothelium-dependent vasodilation to a similar extent . Both interventions together seem to produce additive effects with respect to endothelium-dependent vasodilation Exercise training improves functional capacity in patients with exercise limitation attributed to systolic dysfunction ( SD ) , but exercise training effects in patients with diastolic dysfunction is unclear . The authors determined the functional capacity , quality of life , and echocardiography responses of heart failure with preserved ejection fraction ( HFpEF ) patients to 16 weeks exercise training .  Thirty patients with HFpEF were r and omized to an  exercise training or non-exercising control group . The patients had a baseline mean age of 64 ± 8 years , left ventricular ejection fraction 57 % ± 10 % , and peak oxygen consumption ( peak VO(2 ) ) of 13.3 ± 
    Output:
    
Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction