心力衰竭且射血分数正常患者在中等强度运动时近端动脉僵硬度和心脏反应增加。

Increased proximal arterial stiffness and cardiac response with moderate exercise in patients with heart failure and preserved ejection fraction.

机构信息

Hôpital Léon Bérard, Réadaptation Cardiaque, Hyères, France.

出版信息

J Am Coll Cardiol. 2012 Jan 31;59(5):455-61. doi: 10.1016/j.jacc.2011.10.873.

DOI:10.1016/j.jacc.2011.10.873

PMID:22281248

Abstract

OBJECTIVES

This study sought to demonstrate that arterial stiffness is probably underestimated in patients with heart failure with preserved ejection fraction (HFpEF) at rest and may be revealed with moderate exercise.

BACKGROUND

HFpEF is associated with ventriculoarterial stiffening.

METHODS

We compared 23 patients with stable chronic HFpEF, left ventricular ejection fraction >45%, and impaired relaxation with 15 controls without cardiac disease. Patients were compared at rest and during a 30-W exercise. The following variables were measured or calculated by Doppler echocardiography and tonometry: left ventricular volumes and end-systolic elastance (Ees), peripheral resistance, arterial elastance (Ea), arterial compliance, aortic pulse wave velocity, and carotid Peterson modulus (Ep).

RESULTS

Patients with HFpEF were comparable to controls in age, sex ratio, blood pressure, and heart rate. Ventriculoarterial coupling, assessed by Ees/Ea and Ees/Ep ratios, was moderately impaired at rest in patients compared with controls (both p < 0.01). HFpEF was associated during exercise with a major increase in Ep (+155 ± 193% vs. -5 ± 28%), pulse wave velocity (+20 ± 30% vs. -7 ± 24%), and Ea (+12 ± 15% vs. -5 ± 10%), and a lower decrease in peripheral resistance (-17 ± 12% vs. -26 ± 12%) (p < 0.05 for all). In addition, HFpEF patients showed a lower increase in stroke volume (+10 ± 16% vs. +21 ± 12%) despite a greater increase in Ees (+20 ± 18% vs. +3 ± 12%) (p < 0.05 for all). Also during exercise, adaptation of proximal ventriculoarterial coupling was impaired in HFpEF patients (Ees/Ep: -26 ± 47% vs. +20 ± 47% for controls) (p < 0.01), with no difference in Ees/Ea.

CONCLUSIONS

In HFpEF patients, moderate exercise leads to a steep increase in proximal afterload that is underestimated at rest and is associated with unfavorable ventriculoarterial coupling and exercise intolerance.

摘要

目的

本研究旨在证明，在射血分数保留的心力衰竭（HFpEF）患者中，动脉僵硬在休息时可能被低估，而在适度运动时可能会显现出来。

背景

HFpEF 与心室-动脉僵硬度增加有关。

方法

我们比较了 23 例稳定的慢性 HFpEF 患者（左心室射血分数>45%，舒张功能障碍）和 15 例无心脏病的对照组。患者在休息和 30W 运动时进行比较。通过多普勒超声心动图和张力测量或计算以下变量：左心室容积和收缩末期弹性（Ees）、外周阻力、动脉弹性（Ea）、动脉顺应性、主动脉脉搏波速度和颈动脉 Peterson 模量（Ep）。

结果

HFpEF 患者在年龄、性别比例、血压和心率方面与对照组无差异。与对照组相比，心室-动脉偶联通过 Ees/Ea 和 Ees/Ep 比值在休息时中度受损（均 p<0.01）。HFpEF 患者在运动时 Ep（+155±193% vs.-5±28%）、脉搏波速度（+20±30% vs.-7±24%）和 Ea（+12±15% vs.-5±10%）显著增加，外周阻力降低（-17±12% vs.-26±12%）（均 p<0.05）。此外，尽管 Ees 增加（+20±18% vs.+3±12%），HFpEF 患者的每搏量增加（+10±16% vs.+21±12%）较低（均 p<0.05）。此外，HFpEF 患者在运动期间近端心室-动脉偶联的适应性受损（Ees/Ep：-26±47% vs.对照组+20±47%）（p<0.01），而 Ees/Ea 无差异。