Grewal Jasmine, McCully Robert B, Kane Garvan C, Lam Carolyn, Pellikka Patricia A
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
JAMA. 2009 Jan 21;301(3):286-94. doi: 10.1001/jama.2008.1022.
Limited information exists regarding the role of left ventricular function in predicting exercise capacity and impact on age- and sex-related differences.
To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age.
Cross-sectional study of patients undergoing exercise echocardiography with routine measurements of left ventricular systolic and diastolic function by 2-dimensional and Doppler techniques. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity.
Large tertiary referral center in Rochester, Minnesota, in 2006.
Patients undergoing exercise echocardiography using the Bruce protocol (N = 2867). Patients with echocardiographic evidence of exercise-induced ischemia, ejection fractions lower than 50%, or significant valvular heart disease were excluded.
Exercise capacity in metabolic equivalents (METs).
Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, after multivariate adjustment, those with moderate/severe resting diastolic dysfunction (-1.30 METs; 95% confidence interval [CI], -1.52 to -0.99; P < .001) and mild resting diastolic dysfunction (-0.70 METs; 95% CI, -0.88 to -0.46; P < .001) had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity. Left ventricular filling pressures measured by resting E/e' of 15 or greater (-0.41 METs; 95% CI, -0.70 to -0.11; P = .007) or postexercise E/e' of 15 or greater (-0.41 METs; 95% CI, -0.71 to -0.11; P = .007) were similarly associated with a reduction in exercise capacity, each in separate multivariate analyses. Individuals with impaired relaxation (mild dysfunction) or resting E/e' of 15 or greater had a progressive increase in the magnitude of reduction in exercise capacity with advancing age (P < .001 and P = .02, respectively). Other independent correlates of exercise capacity were age (unstandardized beta coefficient, -0.85 METs; 95% CI, -0.92 to -0.77, per 10-year increment; P < .001), female sex (-1.98 METs; 95% CI, -2.15 to -1.84; P < .001), and body mass index greater than 30 (-1.24 METs; 95% CI, -1.41 to -1.10; P < .001).
In this large cross-sectional study of those referred for exercise echocardiography and not limited by ischemia, abnormalities of left ventricular diastolic function were independently associated with exercise capacity.
关于左心室功能在预测运动能力以及对年龄和性别差异影响方面的信息有限。
确定超声心动图评估的心脏功能指标对运动能力的影响，并确定这些关联是否因性别或年龄增长而改变。
对接受运动超声心动图检查的患者进行横断面研究，采用二维和多普勒技术常规测量左心室收缩和舒张功能。进行分析以确定运动能力的最强相关因素以及这些变量与运动能力的年龄和性别相互作用。
2006年位于明尼苏达州罗切斯特的大型三级转诊中心。
采用布鲁斯方案进行运动超声心动图检查的患者（N = 2867）。排除有运动诱发缺血的超声心动图证据、射血分数低于50%或有严重瓣膜性心脏病的患者。
以代谢当量（METs）表示的运动能力。
舒张功能障碍与运动能力呈强烈负相关。与正常功能相比，多变量调整后，静息时中度/重度舒张功能障碍者（-1.30 METs；95%置信区间[CI]，-1.52至-0.99；P <.001）和静息时轻度舒张功能障碍者（-0.70 METs；95% CI，-0.88至-0.46；P <.001）的运动能力显著降低。左心室收缩功能在正常范围内的变化与运动能力无关。静息时E/e'为15或更高（-0.41 METs；95% CI，-0.70至-0.11；P =.007）或运动后E/e'为15或更高（-0.41 METs；95% CI，-0.71至-0.11；P =.007）在单独的多变量分析中同样与运动能力降低相关。舒张功能受损（轻度功能障碍）或静息时E/e'为15或更高的个体，随着年龄增长，运动能力降低的幅度逐渐增加（分别为P <.001和P =.02）。运动能力的其他独立相关因素为年龄（未标准化β系数，-0.85 METs；95% CI，-0.92至-0.77，每增加10岁；P <.001）、女性（-1.98 METs；95% CI，-2.15至-1.84；P <.001）以及体重指数大于30（-1.24 METs；95% CI，-1.41至-1.10；P <.001）。
在这项针对接受运动超声心动图检查且不受缺血限制的人群的大型横断面研究中，左心室舒张功能异常与运动能力独立相关。
