Tumminello Gabriele, Guazzi Marco, Lancellotti Patrizio, Piérard Luc A
Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
Eur Heart J. 2007 Mar;28(6):673-8. doi: 10.1093/eurheartj/ehl404. Epub 2006 Nov 23.
Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and prognostic value. The pathophysiology determining exercise ventilatory inefficiency is complex and not definitively clarified. Three different mechanisms have been identified: (i) increased dead space, (ii) early occurrence of lactic acidosis, and (iii) abnormal chemoreflex and/or metaboreflex activity. Besides its prognostic value, abnormal ventilation can be influenced by pharmacological and non-pharmacological therapies such as beta-blockers, selective cyclic 3'-5' guanosine monosphosphate phosphodiesterase inhibitors, physical training, and nocturnal continuous positive airway pressure. There is an increasing interest for the exercise periodic breathing, which is frequently associated with HF syndrome and has prognostic importance. The precise mechanisms sustaining exercise periodic breathing are not fully defined but ventilatory and metabo-haemodynamic hypotheses have been proposed.
心力衰竭（HF）是一种以心肌功能障碍和预后不良为特征的复杂综合征。在多种严重程度标志物中，运动通气效率低下具有重要的临床和预后价值。决定运动通气效率低下的病理生理学很复杂，尚未完全阐明。已确定三种不同机制：（i）死腔增加，（ii）乳酸酸中毒早期发生，以及（iii）异常化学反射和/或代谢反射活动。除了其预后价值外，异常通气可受药物和非药物治疗的影响，如β受体阻滞剂、选择性环3'-5'鸟苷单磷酸磷酸二酯酶抑制剂、体育锻炼和夜间持续气道正压通气。人们对运动性周期性呼吸越来越感兴趣，它常与HF综合征相关且具有预后重要性。维持运动性周期性呼吸的确切机制尚未完全明确，但已提出通气和代谢-血液动力学假说。
