Division of Cardiology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States.
Int J Cardiol. 2013 Sep 10;167(6):2734-8. doi: 10.1016/j.ijcard.2012.06.104. Epub 2012 Jul 15.
Exercise has been shown to beneficially alter arterial stiffness in selected clinical settings. However, the effects of a standardized exercise protocol--"cardiac rehabilitation (CR)"--on measures of arterial stiffness in patients with established coronary heart disease (CHD) has not been well studied.
Using applanation tonometry, we studied arterial vascular properties in 26 men and 22 women (mean age 60.5 ± 10.8 years) with established CHD over a 20 week CR program. All patients continued to receive their anti-anginal and vasoactive medications. In addition to standard hemodynamics we estimated central aortic pressure, central arterial pulsatility, augmentation index and arterial pulse wave velocity (PWV).
After 20 weeks of CR, there were no significant changes in resting heart rate or peripheral blood pressure. In 33 patients with at least two follow-up visits, central aortic systolic pressure was consistently lower than peripheral arterial blood pressure and decreased over the CR program time (baseline, 109 ± 16 mmHg; final, 105 ± 14 mmHg. p=0.01). Both carotid-radial (n=12) and carotid-femoral (n=21) - derived PWV decreased over the CR program (carotid-radial: baseline, 7.3 ± 1.2m/s; final, 6.6 ± 1.2m/s, p=0.028. carotid-femoral: baseline, 7.2 ± 1.4m/s; final, 6.5 ± 1.3m/s, p=0.02).
In this group of patients with established CHD, arterial PWV was noted to significantly decrease over a 20 week CR program. This change occurred in the absence of detectable changes in peripheral blood pressure or heart rate. Decreases in PWV may serve as a sensitive indicator of improved arterial stiffness in patients with atherosclerotic arterial disease notwithstanding ongoing medical therapy.
运动已被证明可在特定临床环境中有益地改变动脉僵硬度。然而，标准化运动方案——“心脏康复（CR）”——对已确诊冠心病（CHD）患者动脉僵硬度的影响尚未得到很好的研究。
我们使用平板张力法研究了 26 名男性和 22 名女性（平均年龄 60.5 ± 10.8 岁）在 20 周的 CR 计划期间的动脉血管特性。所有患者继续接受抗心绞痛和血管活性药物治疗。除了标准的血液动力学参数外，我们还评估了中心主动脉压、中心动脉搏动性、增强指数和动脉脉搏波速度（PWV）。
在 20 周的 CR 后，静息心率或外周血压没有明显变化。在至少有两次随访的 33 名患者中，中心主动脉收缩压始终低于外周动脉血压，并在 CR 计划期间逐渐降低（基线时为 109 ± 16 mmHg；最终时为 105 ± 14 mmHg，p=0.01）。颈动脉-桡动脉（n=12）和颈动脉-股动脉（n=21）衍生的 PWV 在 CR 计划期间均降低（颈动脉-桡动脉：基线时为 7.3 ± 1.2m/s；最终时为 6.6 ± 1.2m/s，p=0.028. 颈动脉-股动脉：基线时为 7.2 ± 1.4m/s；最终时为 6.5 ± 1.3m/s，p=0.02）。
在这群患有 CHD 的患者中，动脉 PWV 在 20 周的 CR 计划中显著降低。这种变化发生在外周血压或心率没有明显变化的情况下。尽管继续进行医学治疗，但 PWV 的降低可能是动脉粥样硬化性动脉疾病患者动脉僵硬度改善的敏感指标。
