Division of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
Circ J. 2011;75(7):1649-55. doi: 10.1253/circj.cj-10-0899. Epub 2011 May 25.
It remains unclear whether patients with chronic heart failure (CHF) and advanced left ventricular (LV) dysfunction on β-blocker therapy benefit from exercise training (ET).
We studied 45 CHF patients with advanced LV dysfunction [ejection fraction (LVEF) < 25%] and impaired exercise tolerance [normalized peak oxygen uptake (PVO₂) < 70%] receiving a β-blocker: 33 patients participated in a cardiac rehabilitation program with ET (ET group) and 12 did not (inactive control group). Exercise capacity, LV dimension and plasma B-type natriuretic peptide (BNP) were assessed before and after a 3-month study period. At baseline, both groups had markedly reduced LVEF (ET group 18 ± 4% vs. Control group 18 ± 5%, NS) and impaired exercise capacity (normalized PVO₂ 51 ± 10% vs. 55 ± 9%, NS). Although one patient in the ET group withdrew from the program due to worsening CHF, no serious cardiac events occurred during the ET sessions. After 3 months, the ET group (n = 24) had significantly improved PVO₂ by 16 ± 15% (1,005 ± 295 to 1,167 ± 397ml/min, P < 0.001), while the PVO₂ of the control group was unchanged. LV end-diastolic dimension decreased in both groups to a similar extent, but plasma BNP was significantly decreased only in the ET group (432 to 214 pg/ml, P < 0.05).
The data indicate that in CHF patients with advanced LV dysfunction on β-blocker therapy, ET successfully improves exercise capacity and BNP without adversely affecting LV remodeling or causing serious cardiac complications.
目前尚不清楚接受β受体阻滞剂治疗的慢性心力衰竭（CHF）和左心室（LV）功能障碍晚期的患者是否受益于运动训练（ET）。
我们研究了 45 例 LV 功能障碍晚期（射血分数[LVEF] < 25%）和运动耐量受损[校正后的峰值摄氧量（PVO₂）< 70%]的 CHF 患者，他们正在接受β受体阻滞剂治疗：33 例患者参加了心脏康复计划并进行了 ET（ET 组），12 例未参加（非活动对照组）。在研究的 3 个月期间前后评估了运动能力、LV 尺寸和血浆 B 型利钠肽（BNP）。在基线时，两组的 LVEF 均明显降低（ET 组 18 ± 4% vs. 对照组 18 ± 5%，无统计学差异），运动能力也受损（校正后的 PVO₂ 51 ± 10% vs. 55 ± 9%，无统计学差异）。尽管 ET 组中有 1 例患者因 CHF 恶化而退出该方案，但在 ET 期间未发生严重心脏事件。3 个月后，ET 组（n = 24）的 PVO₂ 显著提高了 16 ± 15%（1,005 ± 295 至 1,167 ± 397ml/min，P < 0.001），而对照组的 PVO₂则无变化。两组的 LV 舒张末期直径均减小，但只有 ET 组的 BNP 显著降低（432 至 214pg/ml，P < 0.05）。
数据表明，在接受β受体阻滞剂治疗的 LV 功能障碍晚期 CHF 患者中，ET 成功地提高了运动能力和 BNP，而不会对 LV 重构产生不利影响或导致严重的心脏并发症。
