Rerkpattanapipat Pairoj, Hundley W Gregory, Link Kerry M, Brubaker Peter H, Hamilton Craig A, Darty Stephen N, Morgan Timothy M, Kitzman Dalane W
Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
Am J Cardiol. 2002 Dec 1;90(11):1221-5. doi: 10.1016/s0002-9149(02)02838-2.
Aortic stiffness increases with advancing age and is associated with the age-related decline in exercise capacity in healthy persons. Previous studies have suggested that aortic compliance is reduced in heart failure (HF). Older persons with systolic HF can have particularly severe exercise intolerance. However, the relation between increased aortic stiffness and exercise intolerance in elderly patients with systolic HF has not been examined. Therefore, aortic distensibility of the proximal ascending aorta (assessed by magnetic resonance imaging) and exercise tolerance (assessed by maximal exercise ergometry with expired gas analysis) was measured in 28 subjects (10 healthy subjects aged 20 to 30 years, 10 healthy subjects aged > or =60 years, and 8 subjects aged > or =60 years with systolic HF). Compared with healthy older subjects, patients with systolic HF had markedly decreased distensibility of the proximal aorta (0.5 +/- 0.4 vs 2.2 +/- 1.2 10(-3) mm Hg(-1), p <0.002), decreased peak exercise volume of oxygen consumption (VO2) (858 +/- 248 vs 1,436 +/- 344 ml/min, p <0.001), and increased aortic wall thickness (3.6 +/- 0.7 vs 2.9 +/- 0.4 mm, p <0.04). Aortic distensibility was significantly correlated with peak VO2 (r = 0.80, p <0.0001) and remained so even after being adjusted for age and left ventricular (LV) ejection fraction. These data suggest that decreased aortic distensibility may contribute to exercise intolerance in older patients with HF due to LV systolic dysfunction.
随着年龄增长，主动脉僵硬度增加，且与健康人群中与年龄相关的运动能力下降有关。先前的研究表明，心力衰竭（HF）患者的主动脉顺应性降低。患有收缩期HF的老年人可能存在特别严重的运动不耐受。然而，老年收缩期HF患者中主动脉僵硬度增加与运动不耐受之间的关系尚未得到研究。因此，对28名受试者（10名年龄在20至30岁的健康受试者、10名年龄≥60岁的健康受试者以及8名年龄≥60岁的收缩期HF患者）测量了升主动脉近端的主动脉扩张性（通过磁共振成像评估）和运动耐量（通过带有呼出气体分析的最大运动测力计评估）。与健康老年受试者相比，收缩期HF患者的主动脉近端扩张性显著降低（0.5±0.4对2.2±1.2×10⁻³ mmHg⁻¹，p<0.002），运动时氧耗峰值（VO₂）降低（858±248对1436±344 ml/min，p<0.001），且主动脉壁厚度增加（3.6±0.7对2.9±0.4 mm，p<0.04）。主动脉扩张性与VO₂峰值显著相关（r = 0.80，p<0.0001），即使在调整年龄和左心室（LV）射血分数后仍保持这种相关性。这些数据表明，主动脉扩张性降低可能导致老年LV收缩功能障碍所致HF患者出现运动不耐受。
