Piña Ileana L, Kokkinos Peter, Kao Andrew, Bittner Vera, Saval Matt, Clare Bob, Goldberg Lee, Johnson Maryl, Swank Ann, Ventura Hector, Moe Gordon, Fitz-Gerald Meredith, Ellis Stephen J, Vest Marianne, Cooper Lawton, Whellan David
Case Western Reserve University, Cleveland VA Medical Center, Education Department, Wade Park, Cleveland, OH 44106, USA.
Am Heart J. 2009 Oct;158(4 Suppl):S16-23. doi: 10.1016/j.ahj.2009.07.012.
In patients with heart failure (HF), assessment of functional capacity plays an important prognostic role. Both 6-minute walk and cardiopulmonary exercise testing have been used to determine physical function and to determine prognosis and even listing for transplantation. However, as in HF trials, the number of women reported has been small, and the cutoffs for transplantation have been representative of male populations and extrapolated to women. It is also well known that peak VO(2) as a determinant of fitness is inherently lower in women than in men and potentially much lower in the presence of HF. Values for a female population from which to draw for this important determination are lacking.
The HF-ACTION trial randomized 2,331 patients (28% women) with New York Heart Association class II-IV HF due to systolic dysfunction to either a formal exercise program in addition to optimal medical therapy or to optimal medical therapy alone without any formal exercise training. To characterize differences between men and women in the interpretation of final cardiopulmonary exercise testing models, the interaction of individual covariates with sex was investigated in the models of (1) VE/VCO(2), (2) VO(2) at ventilatory threshold (VT), (3) distance on the 6-minute walk, and (4) peak VO(2).
The women were younger than the men and more likely to have a nonischemic etiology and a higher ejection fraction. Dose of angiotensin converting enzyme inhibitor (ACEI) was lower in the women, on average. The lower ACEI dose may reflect the higher use of angiotensin II receptor blocker (ARB) in women. Both the peak VO(2) and the 6-minute walk distance were significantly lower in the women than in the men. Perhaps the most significant finding in this dataset of baseline characteristics is that the peak VO(2) for women was significantly lower than that for men with similar ventricular function and health status.
Therefore, in a well-medicated, stable, class II-IV HF cohort of patients who are able to exercise, women have statistically significantly lower peak VO(2) and 6-minute walk distance than men with similar health status and ventricular function. These data should prompt careful thought when considering prognostic markers for women and listing for cardiac transplant.
在心力衰竭（HF）患者中，功能能力评估具有重要的预后作用。6分钟步行试验和心肺运动试验都已被用于确定身体功能、判断预后甚至确定是否适合移植。然而，正如在HF试验中一样，报道的女性患者数量较少，移植的临界值是基于男性人群得出并外推至女性的。众所周知，作为健康状况决定因素的峰值摄氧量（VO₂）在女性中天生就低于男性，在存在HF时可能更低。目前缺乏用于这一重要判定的女性人群数据。
HF-ACTION试验将2331例因收缩功能障碍导致纽约心脏协会II-IV级HF的患者（28%为女性）随机分为两组，一组接受除最佳药物治疗外的正式运动计划，另一组仅接受最佳药物治疗而无任何正式运动训练。为了描述男女在最终心肺运动试验模型解读方面的差异，在以下模型中研究了个体协变量与性别的相互作用：（1）VE/VCO₂，（2）通气阈值（VT）时的VO₂，（3）6分钟步行距离，以及（4）峰值VO₂。
女性比男性年轻，更有可能有非缺血性病因且射血分数更高。平均而言，女性使用血管紧张素转换酶抑制剂（ACEI）的剂量较低。较低的ACEI剂量可能反映出女性中血管紧张素II受体阻滞剂（ARB）的使用较多。女性的峰值VO₂和6分钟步行距离均显著低于男性。在这个基线特征数据集中，也许最显著的发现是，具有相似心室功能和健康状况的女性的峰值VO₂显著低于男性。
因此，在一组能够运动、接受了充分药物治疗且病情稳定的II-IV级HF患者队列中，女性的峰值VO₂和6分钟步行距离在统计学上显著低于具有相似健康状况和心室功能的男性。在考虑女性的预后标志物和心脏移植名单时，这些数据应促使人们仔细思考。
