Cardiology Department, General Hospital G.Genimmatas, Athens, Greece.
J Card Fail. 2010 Mar;16(3):244-9. doi: 10.1016/j.cardfail.2009.10.023. Epub 2009 Dec 11.
Functional electrical stimulation (FES) improves exercise capacity and quality of life in chronic heart failure (CHF) patients. However, there is no evidence regarding the effectiveness of this treatment modality according to the severity of CHF. This study compares the effectiveness of FES on exercise capacity, endothelial function, neurohormonal status, and emotional stress in New York Heart Association (NYHA) III-IV versus NYHA II patients.
Eighteen NYHA II and 13 age- and sex-matched NYHA III-IV patients with stable CHF (left ventricular ejection fraction <35%) underwent a 6-week FES training program. Questionnaires addressing quality of life (Kansas City Cardiomyopathy Questionnaire, functional and overall), and emotional stress (Zung self-rating depression scale, Beck Depression Inventory), as well as plasma B-type natriuretic peptide (BNP), 6-minute walking distance test (6MWT), and endothelial function (flow-mediated dilatation [FMD]) were assessed at baseline and after completion of training protocol. 6MWT and plasma BNP improved significantly in 2 patient groups (both P < .001) after training program. The improvement of BNP was statistically greater in NYHA III-IV patients posttreatment than in those with NYHA II class (F=315.342, P < .001). Similarly, the improvement of 6MWT was statistically greater in NYHA III-IV group than in NYHA II patients (F=79.818, P < .001). Finally, an FES-induced greater improvement of FMD (F=9.517, P=.004) and emotional stress scores was observed in NYHA III-IV patients in comparison to NYHA II patients. There was a higher proportion of NYHA III-IV patients adhering to the FES training program for additional 3 months compared with the NYHA II group of patients (76.9% vs. 55.6%, P < .001).
FES might exert a greater beneficial effect on clinical and neurohormonal status of NYHA III-IV patients in comparison to NYHA II patients. This effect may have important clinical relevance leading to increased adherence of severe CHF patients to exercise rehabilitation programs.
功能性电刺激（FES）可提高慢性心力衰竭（CHF）患者的运动能力和生活质量。然而，根据 CHF 的严重程度，尚无关于这种治疗方式有效性的证据。本研究比较了 FES 对纽约心脏协会（NYHA）III-IV 级与 NYHA II 级患者运动能力、内皮功能、神经激素状态和情绪应激的影响。
18 名 NYHA II 级和 13 名年龄和性别匹配的 NYHA III-IV 级稳定 CHF（左心室射血分数<35%）患者接受了 6 周的 FES 训练计划。在基线和训练方案完成后，使用问卷调查评估生活质量（堪萨斯城心肌病问卷、功能和总体）和情绪应激（Zung 自评抑郁量表、贝克抑郁量表），以及血浆 B 型利钠肽（BNP）、6 分钟步行试验（6MWT）和内皮功能（血流介导的扩张[FMD]）。两组患者在训练计划后 6MWT 和血浆 BNP 均显著改善（均 P<0.001）。治疗后 NYHA III-IV 患者的 BNP 改善程度明显大于 NYHA II 级患者（F=315.342，P<0.001）。同样，NYHA III-IV 组患者的 6MWT 改善程度也明显大于 NYHA II 组（F=79.818，P<0.001）。最后，与 NYHA II 组相比，NYHA III-IV 组患者的 FMD（F=9.517，P=0.004）和情绪应激评分的 FES 诱导改善更大。与 NYHA II 组相比，NYHA III-IV 组患者更愿意坚持接受 FES 训练计划（76.9%对 55.6%，P<0.001）。
与 NYHA II 级患者相比，FES 可能对 NYHA III-IV 级患者的临床和神经激素状态产生更大的有益影响。这种影响可能具有重要的临床意义，导致严重 CHF 患者对运动康复计划的依从性增加。
