Gallagher Michael J, Franklin Barry A, Ehrman Jonathan K, Keteyian Steven J, Brawner Clinton A, deJong Adam T, McCullough Peter A
Division of Cardiology, William Beaumont Hospital, 4949 Coolidge Hwy, Royal Oak, MI 48073, USA.
Chest. 2005 Jun;127(6):2197-203. doi: 10.1378/chest.127.6.2197.
We are in the midst of an obesity pandemic. Morbid obesity is associated with dyspnea on exertion and higher overall mortality rates. The relations between measures of cardiorespiratory fitness in morbidly obese persons compared to those with heart failure are unknown.
We compared cardiorespiratory fitness in patients with morbid obesity (n = 43) and established systolic dysfunction heart failure (n = 235), and in age-matched medical control subjects (n = 222) who had been referred for diagnostic exercise testing with simultaneous metabolic measurements. Only patients who completed an adequate test for maximum exertion manifested by a respiratory exchange ratio of > or = 1.10 were included in the study.
The mean (+/- SD) body mass index (BMI) values for the three groups were 47.8 +/- 5.1, 30.1 +/- 5.7, and 33.8 +/- 9.0, respectively (p < 0.0001 for comparisons between morbidly obese patients and each comparator). The mean left ventricular ejection fraction for the heart failure group was 21.5 +/- 8.4%. Despite achieving higher peak heart rate and BP values, the morbidly obese patients had a mean maximum oxygen uptake (V(O2)max) that was similar to that of those with heart failure (17.8 +/- 3.6 vs 16.5 +/- 5.6 mL/kg/min, respectively; p = 0.14) and was considerably lower than that of the control group (17.8 +/- 3.6 vs 21.3 +/- 8.2 mL/kg/min, respectively; p = 0.007). In addition, among subjects in the control group, there was a graded inverse relation between BMI and V(O2)max.
Morbidly obese individuals have severely reduced cardiorespiratory fitness that is similar to those with established systolic dysfunction heart failure. In addition, in those persons who are referred for stress testing for medical reasons, there is an inverse graded relationship between BMI and cardiorespiratory fitness. These data suggest that the impairment in V(O2)max in morbidly obese persons is related to BMI and possibly to other factors that impair peak cardiac performance. These findings are consistent with overall higher expected mortality in morbidly obese persons.
我们正处于肥胖流行之中。病态肥胖与运动时呼吸困难及更高的总体死亡率相关。与心力衰竭患者相比，病态肥胖者的心肺适能指标之间的关系尚不清楚。
我们比较了病态肥胖患者（n = 43）、已确诊的收缩功能障碍性心力衰竭患者（n = 235）以及年龄匹配的医学对照受试者（n = 222）的心肺适能，这些对照受试者因诊断性运动测试及同步代谢测量而被转诊。只有完成了足够的最大运动测试且呼吸交换率≥1.10的患者才被纳入研究。
三组的平均（±标准差）体重指数（BMI）值分别为47.8±5.1、30.1±5.7和33.8±9.0（病态肥胖患者与各对照组比较，p < 0.0001）。心力衰竭组的平均左心室射血分数为21.5±8.4%。尽管病态肥胖患者达到了更高的峰值心率和血压值，但其平均最大摄氧量（V（O2）max）与心力衰竭患者相似（分别为17.8±3.6 vs 16.5±5.6 mL/kg/min；p = 0.14），且显著低于对照组（分别为17.8±3.6 vs 21.3±8.2 mL/kg/min；p = 0.007）。此外，在对照组受试者中，BMI与V（O2）max之间存在分级负相关。
病态肥胖个体的心肺适能严重降低，与已确诊的收缩功能障碍性心力衰竭患者相似。此外，在因医学原因接受压力测试的人群中，BMI与心肺适能之间存在分级负相关。这些数据表明，病态肥胖者V（O2）max的损害与BMI有关，可能还与其他损害心脏峰值功能的因素有关。这些发现与病态肥胖者总体预期死亡率较高一致。
