心力衰竭保留射血分数患者进行 1 年渐进性耐力运动训练的心血管效应。
Cardiovascular effects of 1 year of progressive endurance exercise training in patients with heart failure with preserved ejection fraction.
机构信息
The University of Texas Southwestern Medical Center at Dallas, USA.
出版信息
Am Heart J. 2012 Dec;164(6):869-77. doi: 10.1016/j.ahj.2012.06.028. Epub 2012 Oct 29.
BACKGROUND
Heart failure with preserved ejection fraction (HFpEF) is a disease of the elderly with cardiovascular stiffening and reduced exercise capacity. Exercise training appears to improve exercise capacity and cardiovascular function in heart failure with reduced ejection fraction. However, it is unclear whether exercise training could improve cardiovascular stiffness, exercise capacity, and ventricular-arterial coupling in HFpEF.
METHODS
Eleven HFpEF patients and 13 healthy controls underwent invasive measurements with right heart catheterization to define Starling and left ventricular (LV) pressure-volume curves; secondary functional outcomes included Doppler echocardiography, arterial stiffness, cardiopulmonary exercise testing with cardiac output measurement, and ventricular-arterial coupling assessed by the dynamic Starling mechanism. Seven of 11 HFpEF patients (74.9 ± 6 years; 3 men/4 women) completed 1 year of endurance training followed by repeat measurements. Pulmonary capillary wedge pressures and LV end-diastolic volumes were measured at baseline during decreased and increased cardiac filling. LV compliance was assessed by the slope of the pressure-volume curve. Beat-to-beat LV end-diastolic pressure (estimated from pulmonary arterial diastolic pressure) and stroke volume index were obtained, and spectral transfer function analysis was used to assess the dynamic Starling mechanism.
RESULTS
Before training, HFpEF patients had reduced exercise capacity, distensibility and dynamic Starling mechanism but similar LV compliance and end-diastolic volumes compared to controls albeit with elevated filling pressure and increased wall stress. One year of training had little effect on LV compliance and volumes, arterial stiffness, exercise capacity or ventricular-arterial coupling.
CONCLUSION
Contrary to our hypothesis, 1 year of endurance training failed to impart favorable effects on cardiovascular stiffness or function in HFpEF.
背景
射血分数保留的心力衰竭（HFpEF）是一种老年心血管僵硬和运动能力降低的疾病。运动训练似乎可以改善射血分数降低的心力衰竭患者的运动能力和心血管功能。然而，运动训练是否可以改善 HFpEF 患者的心血管僵硬、运动能力和心室-动脉偶联尚不清楚。
方法
11 名 HFpEF 患者和 13 名健康对照者接受了右心导管检查的侵入性测量，以确定 Starling 和左心室（LV）压力-容积曲线；次要功能结果包括多普勒超声心动图、动脉僵硬、带有心输出量测量的心肺运动测试以及通过动态 Starling 机制评估的心室-动脉偶联。11 名 HFpEF 患者中的 7 名（74.9±6 岁；3 名男性/4 名女性）完成了 1 年的耐力训练，随后进行了重复测量。在降低和增加心脏充盈时，在基线时测量肺毛细血管楔压和 LV 舒张末期容积。通过压力-容积曲线的斜率评估 LV 顺应性。获得了 LV 舒张末期压力（从肺动脉舒张压估计）和每搏输出量指数的逐搏值，并使用谱传递函数分析来评估动态 Starling 机制。
结果
在训练前，HFpEF 患者的运动能力、可扩张性和动态 Starling 机制降低，但与对照组相比，LV 顺应性和舒张末期容积相似，尽管充盈压升高和壁应力增加。1 年的训练对 LV 顺应性和容积、动脉僵硬、运动能力或心室-动脉偶联几乎没有影响。
结论
与我们的假设相反，1 年的耐力训练未能在 HFpEF 中产生对心血管僵硬或功能的有利影响。
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