Department of Cardiology, University of Göttingen, Göttingen, Germany.
J Am Coll Cardiol. 2011 Oct 18;58(17):1780-91. doi: 10.1016/j.jacc.2011.06.054.
We sought to determine whether structured exercise training (ET) improves maximal exercise capacity, left ventricular diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF).
Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse.
A total of 64 patients (age 65 ± 7 years, 56% female) with HFpEF were prospectively randomized (2:1) to supervised endurance/resistance training in addition to usual care (ET, n = 44) or to usual care alone (UC) (n = 20). The primary endpoint was the change in peak Vo(2) after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL.
Peak Vo(2) increased (16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg; p < 0.001) with ET and remained unchanged (16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg; p = NS) with UC. The mean benefit of ET was 3.3 ml/min/kg (95% confidence interval [CI]: 1.8 to 4.8, p < 0.001). E/e' (mean difference of changes: -3.2, 95% CI: -4.3 to -2.1, p < 0.001) and left atrial volume index (milliliters per square meter) decreased with ET and remained unchanged with UC (-4.0, 95% CI: -5.9 to -2.2, p < 0.001). The physical functioning score (36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15, 95% CI: 7 to 24, p < 0.001). The ET-induced decrease of E/e' was associated with 38% gain in peak Vo(2) and 50% of the improvement in physical functioning score.
Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF. This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function. (Exercise Training in Diastolic Heart Failure-Pilot Study: A Prospective, Randomised, Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [Ex-DHF-P]; ISRCTN42524037).
我们旨在确定结构性运动训练（ET）是否能改善射血分数保留的心力衰竭（HFpEF）患者的最大运动能力、左心室舒张功能和生活质量（QoL）。
近一半心力衰竭患者患有 HFpEF，但有效的治疗策略却很少。
共 64 名 HFpEF 患者（年龄 65±7 岁，56%为女性）前瞻性随机分为（2:1）接受监督耐力/抗阻训练加常规治疗（ET，n=44）或单独常规治疗（UC，n=20）。主要终点为 3 个月后峰值 Vo（2）的变化。次要终点包括对心脏结构、舒张功能和 QoL 的影响。
峰值 Vo（2）增加（16.1±4.9ml/min/kg 增加到 18.7±5.4ml/min/kg；p＜0.001），而 UC 则保持不变（16.7±4.7ml/min/kg 增加到 16.0±6.0ml/min/kg；p=NS）。ET 的平均获益为 3.3ml/min/kg（95%置信区间[CI]：1.8 至 4.8，p＜0.001）。E/e'（变化的平均值差异：-3.2，95%CI：-4.3 至-2.1，p＜0.001）和左心房容积指数（毫升/平方米）下降，而 UC 则保持不变（-4.0，95%CI：-5.9 至-2.2，p＜0.001）。ET 可改善健康调查 36 项简表（SF-36）的身体功能评分（15，95%CI：7 至 24，p＜0.001），而 UC 则保持不变。ET 诱导的 E/e'降低与峰值 Vo（2）增加 38%和身体功能评分提高 50%相关。
运动训练可改善 HFpEF 患者的运动能力和生活质量的身体维度。这种益处与心房反向重构和改善左心室舒张功能有关。（运动训练在舒张性心力衰竭中的作用——一项前瞻性、随机、对照研究，以确定体力训练对运动能力和生活质量的影响[Ex-DHF-P]；ISRCTN42524037）。
