Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Int J Cardiovasc Imaging. 2013 Apr;29(4):777-85. doi: 10.1007/s10554-012-0152-z. Epub 2012 Nov 18.
Diastolic dysfunction is common in coronary artery disease (CAD). Exercise-based cardiac rehabilitation (CR) improves survival and quality of life but its effect on diastolic function is unclear. We sought to determine the impact of CR on diastolic function. We conducted a prospective study of CAD patients referred for 3-month outpatient CR, with pre-CR and post-CR echocardiograms. Twenty-five outpatients (age [mean ± SD], 66 ± 11 ! years; 7 [28 %] women; 22 [88 %] with recent acute coronary syndrome) were recruited upon beginning CR; one patient lacking follow-up was excluded from analysis. Before CR, patients' mean ejection fraction was 61 ± 7 %; regional wall motion score index was 1.18 ± 0.28; and left ventricular diastolic dysfunction existed in 21 (88 %). Of the 24 (96 %) patients with post-CR follow-up, 12 (50 %) had improved diastolic function, 2 of the 24 (8 %) had normal diastolic function throughout, nine (38 %) remained at the same grade, and one (4 %) had worsened diastolic function. The E/e' ratio improved significantly after CR (11.9 ± 4.5 vs. 10.7 ± 4.5; P = .048). Fourteen patients with normal or improved diastolic function had a greater decrease in left atrial volume index (-4.2 ± 6.3 vs. 1.6 ± 6.3 mL/m(2); P = .04) and a greater increase in peak untwisting rate (20 ± 36 vs. -42 ± 45 °/s; P = .003) than did patients with no diastolic improvement. Three-month, exercise-based CR was associated with improved left ventricular diastolic function in half of our patients. Further large studies are needed to clarify the effect of CR on diastolic dysfunction in patients with CAD.
舒张功能障碍在冠状动脉疾病（CAD）中很常见。基于运动的心脏康复（CR）可改善生存率和生活质量，但它对舒张功能的影响尚不清楚。我们旨在确定 CR 对舒张功能的影响。我们进行了一项前瞻性研究，纳入了接受 3 个月门诊 CR 的 CAD 患者，在 CR 前和 CR 后进行了超声心动图检查。在开始 CR 时，招募了 25 名门诊患者（年龄[平均值±标准差]，66 ± 11 岁；7 [28%]名女性；22 [88%]名近期急性冠状动脉综合征）；一名缺乏随访的患者被排除在分析之外。在 CR 前，患者的平均射血分数为 61 ± 7%；区域性壁运动评分指数为 1.18 ± 0.28；21 名（88%）患者存在舒张功能障碍。在 24 名（96%）有 CR 后随访的患者中，12 名（50%）的舒张功能得到改善，24 名（8%）的患者始终存在正常的舒张功能，9 名（38%）的患者保持相同的等级，1 名（4%）的患者的舒张功能恶化。CR 后 E/e'比值显著改善（11.9 ± 4.5 比 10.7 ± 4.5；P =.048）。14 名舒张功能正常或改善的患者左心房容积指数下降更明显（-4.2 ± 6.3 比 1.6 ± 6.3 mL/m2；P =.04），峰值解旋率增加更明显（20 ± 36 比-42 ± 45 °/s；P =.003），而舒张功能无改善的患者则没有。3 个月，基于运动的 CR 与我们患者中一半的左心室舒张功能改善相关。需要进一步的大型研究来阐明 CR 对 CAD 患者舒张功能障碍的影响。
