心脏移植受者和轻度慢性心力衰竭患者对运动的通气反应及氧恢复动力学相似。
Ventilatory response to exercise and kinetics of oxygen recovery are similar in cardiac transplant recipients and patients with mild chronic heart failure.
作者信息
Nanas Serafim N, Terrovitis John V, Charitos Christos, Papazachou Ourania, Margari Zafiria, Tsagalou Eleftheria P, Kassiotis Christos, Tsolakis Elias, Toumanidis Savas, Nanas John N
机构信息
Pulmonary & Critical Care Medicine Department, National and Kapodestrian University, Athens, Greece.
出版信息
J Heart Lung Transplant. 2004 Oct;23(10):1154-9. doi: 10.1016/j.healun.2003.08.029.
BACKGROUND
Exercise capacity, assessed by cardiopulmonary exercise treadmill testing (CPET), does not return to normal following heart transplantation. This study evaluated the ventilatory response to exercise and the kinetics of oxygen (O(2)) recovery in heart transplant recipients (HTR) compared to healthy volunteers (HV) and heart failure patients.
METHODS
Eighteen patients with end-stage heart failure (ESHF), 12 with mild heart failure (MHF) matched for peak oxygen consumption (Vo(2)) with the HTR, 12 HTR and 12 HV underwent CPET for measurements of peak Vo(2), Vo(2) at anaerobic threshold (AT), first-degree slope of Vo(2) decline during early recovery (Vo(2)/t-slope), time required for a 50% fall from peak Vo(2) (T(1/2) of Vo(2)) and the slopes of VE/Vco(2) and VE/Vo(2).
RESULTS
The MHF and HTR groups had similar ventilatory responses to exercise and O(2) recovery kinetics. Peak Vo(2) (18.5 +/- 5.7 vs 9.4 +/- 0.9 ml/kg/min, p < 0.001), AT (13.8 +/- 4.8 vs 6.7 +/- 1.8 ml/kg/min, p < 0.001) and Vo(2)/t-slope (0.6 +/- 0.2 vs 0.3 +/- 0.2 liter/min/min, p = 0.055) were higher in the HTR than in the ESHF group. In contrast, HTR had lower VE/Vco(2)-slope (31.4 +/- 3.8 vs 39.2 +/- 9.9, p = 0.015) and T(1/2) Vo(2) (1.5 +/- 0.3 vs 2.4 +/- 1.1 minute, p = 0.014) than the ESHF group. Compared to HV, HTR had lower Vo(2) peak (18.5 +/- 5.7 vs 28.4 +/- 6.9 ml/kg/min, p < 0.001), AT (13.8 +/- 4.8 vs 19.8 +/- 4.5 ml/kg/min, p = 0.04), Vo(2)/t-slope (0.6 +/- 0.2 vs 1.0 +/- 0.4 liter/min/min, p = 0.005) and steeper VE/Vco(2) slope (31.4 +/- 3.8 vs 23.6 +/- 2.7, p = 0.062). Heart rate deceleration during recovery was significantly slower in HTR than in all other groups.
CONCLUSIONS
Exercise intolerance and delayed O(2) recovery kinetics were only partially reversed after heart transplantation. This finding suggests that some of the pathophysiologic mechanisms of heart failure persist after heart transplantation.
背景
通过心肺运动平板试验（CPET）评估的运动能力在心脏移植后不会恢复正常。本研究评估了心脏移植受者（HTR）与健康志愿者（HV）和心力衰竭患者相比，运动时的通气反应以及氧（O₂）恢复动力学。
方法
18例终末期心力衰竭（ESHF）患者、12例与HTR峰值耗氧量（Vo₂）匹配的轻度心力衰竭（MHF）患者、12例HTR患者和12例HV患者接受CPET，以测量峰值Vo₂、无氧阈（AT）时的Vo₂、早期恢复期间Vo₂下降的一级斜率（Vo₂/t斜率）、从峰值Vo₂下降50%所需的时间（Vo₂的T₁/₂）以及VE/Vco₂和VE/Vo₂的斜率。
结果
MHF组和HTR组在运动通气反应和O₂恢复动力学方面相似。HTR组的峰值Vo₂（18.5±5.7对9.4±0.9 ml/kg/min，p<0.001）、AT（13.8±4.8对6.7±1.8 ml/kg/min，p<0.001）和Vo₂/t斜率（0.6±0.2对0.3±0.2升/分钟/分钟，p = 0.055）高于ESHF组。相比之下，HTR组的VE/Vco₂斜率（31.4±3.8对39.2±9.9，p = 0.015）和Vo₂的T₁/₂（1.5±0.3对2.4±1.1分钟，p = 0.014）低于ESHF组。与HV相比，HTR组的峰值Vo₂较低（18.5±5.7对28.4±6.9 ml/kg/min，p<0.001）、AT较低（13.8±4.8对19.8±4.5 ml/kg/min，p = 0.04）、Vo₂/t斜率较低（0.6±0.2对1.0±0.4升/分钟/分钟，p = 0.005）且VE/Vco₂斜率更陡（31.4±3.8对23.6±2.7，p = 0.062）。HTR组恢复期间心率减速明显慢于所有其他组。
结论
心脏移植后运动不耐受和延迟的O₂恢复动力学仅部分得到逆转。这一发现表明心力衰竭的一些病理生理机制在心脏移植后仍然存在。
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