Gibbs C R, Blann A D, Edmunds E, Watson R D, Lip G Y
Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom.
Clin Cardiol. 2001 Nov;24(11):724-9. doi: 10.1002/clc.4960241107.
Chronic heart failure (CHF) is associated with an increased risk of thrombosis and thromboembolic events, including stroke and venous thromboembolism. which may be related to a prothrombotic or hypercoagulable state. Acute vigorous exercise has been associated with activation of hemostasis, and this risk may well be particularly increased in patients with CHF.
The study was undertaken to determine whether acute exercise would adversely affect abnormalities of hemorheological (fibrinogen, plasma viscosity, hematocrit), endothelial (von Willebrand factor), and platelet markers (soluble P selectin) in patients with CHF.
We studied 22 ambulant outpatients (17 men; mean age 65+/-9 years) with stable CHF (New York Heart Association class II-III and a left ventricular ejection fraction of < or =40%) who were exercised to exhaustion on a treadmill. Results were compared with 20 hospital controls (patients with vascular disease, but free of CHF) and 20 healthy controls.
Baseline von Willebrand factor (p = 0.01) and soluble P-selectin (p = 0.006) levels were significantly elevated in patients with CHF when compared with controls. In the patients with CHF who were exercised, plasma viscosity, fibrinogen, and hematocrit levels increased significantly, both immediately post exercise and at 20 min into the recovery period (repeated measures analysis of variance, all p<0.05). There was a positive correlation between exercise workload and the maximal changes in plasma viscosity in the patients with CHF (Spearman r = 0.5, p = 0.02). Plasma viscosity levels increased with exercise in the hospital control group, although no other exercise-induced changes were noted in this group.
The present study indicates that the hemorheological indices. fibrinogen, and hematocrit specifically increase during acute exercise in patients with CHF. Although moderate exercise should be encouraged in patients with CHF, vigorous exercise should probably be avoided in view of its potential prothrombotic effects in this high-risk group of patients.
慢性心力衰竭（CHF）与血栓形成及血栓栓塞事件风险增加相关，包括中风和静脉血栓栓塞，这可能与血栓前状态或高凝状态有关。急性剧烈运动与止血激活有关，而CHF患者的这种风险可能会特别增加。
本研究旨在确定急性运动是否会对CHF患者的血液流变学（纤维蛋白原、血浆粘度、血细胞比容）、内皮（血管性血友病因子）和血小板标志物（可溶性P选择素）异常产生不利影响。
我们研究了22例稳定型CHF的门诊患者（17例男性；平均年龄65±9岁，纽约心脏协会心功能II - III级，左心室射血分数≤40%），让他们在跑步机上运动至力竭。将结果与20例医院对照者（患有血管疾病但无CHF）和20例健康对照者进行比较。
与对照组相比，CHF患者的基线血管性血友病因子（p = 0.01）和可溶性P选择素水平（p = 0.006）显著升高。在进行运动的CHF患者中，运动后即刻及恢复期20分钟时，血浆粘度、纤维蛋白原和血细胞比容水平均显著升高（重复测量方差分析，所有p<0.05）。CHF患者的运动负荷与血浆粘度的最大变化之间存在正相关（Spearman r = 0.5，p = 0.02）。医院对照组的血浆粘度水平随运动增加，尽管该组未观察到其他运动诱导的变化。
本研究表明，CHF患者在急性运动期间血液流变学指标、纤维蛋白原和血细胞比容会特别增加。尽管应鼓励CHF患者进行适度运动，但鉴于剧烈运动对该高危患者群体具有潜在的促血栓形成作用，可能应避免剧烈运动。
