Cardiac Rehabilitation Institute, Sheba Medical Center, Israel
Cardiac Rehabilitation Institute, Sheba Medical Center, Israel.
Eur J Prev Cardiol. 2015 Jan;22(1):13-9. doi: 10.1177/2047487313501277. Epub 2013 Aug 8.
Recent data suggest that exercise training (ET) confers significant symptomatic and functional improvements in patients with diastolic dysfunction, and thus may be beneficial in patients with hypertrophic cardiomyopathy (HCM). However, there are no data regarding the safety or efficacy of ET in HCM patients.
A prospective non-randomized intervention design was used.
We enrolled 20 patients with symptomatic HCM, significantly limited in everyday activity, into a supervised cardiac rehabilitation exercise program.
Patients were 62 ± 13 years old, in New York Heart Association (NYHA) functional class II (35%) or III (65%), had a mean interventricular septum dimension of 17 ± 5 mm and left ventricular ejection fraction (LVEF) of 53 ± 15%. Left ventricular outflow gradient was present at rest in nine patients (mean 51 ± 24 mm Hg) and six patients had an implantable defibrillator. Exercise prescription was based on heart rate reserve (HRR) determined from a symptom-limited graded exercise stress test. Exercise intensity was gradually increased from 50% to 85% of the HRR over the training period. Patients completed an average of 41 ± 8 hours of aerobic ET. No adverse events or sustained ventricular arrhythmias occurred during the training program. Functional capacity, assessed by a graded exercise test, improved from 4.7 ± 2.2 to 7.2 ± 2.8 metabolic equivalents (METs) (p = 0.01). NYHA functional class improved from baseline by ≥ 1 grade in 10 patients (50%) and none experiencing deterioration during follow-up.
The present study suggests that patients with HCM who remain symptomatic despite medical therapy may achieve considerable functional improvement through a supervised ET program.
最近的数据表明，运动训练（ET）可显著改善舒张功能障碍患者的症状和功能，因此对肥厚型心肌病（HCM）患者可能有益。然而，目前尚无关于 HCM 患者 ET 的安全性或疗效的数据。
采用前瞻性非随机干预设计。
我们纳入了 20 名有症状的 HCM 患者，这些患者的日常活动受到显著限制，参加了一项监督下的心脏康复运动计划。
患者年龄为 62 ± 13 岁，纽约心脏协会（NYHA）功能分级 II 级（35%）或 III 级（65%），室间隔厚度为 17 ± 5mm，左心室射血分数（LVEF）为 53 ± 15%。9 名患者静息时存在左室流出道梯度（平均 51 ± 24mmHg），6 名患者有植入式除颤器。运动处方基于症状限制分级运动负荷试验确定的心率储备（HRR）。在训练期间，运动强度逐渐从 HRR 的 50%增加到 85%。患者平均完成 41 ± 8 小时的有氧运动训练。在训练计划期间，没有发生不良事件或持续性室性心律失常。通过分级运动试验评估的功能能力从基线时的 4.7 ± 2.2 代谢当量（METs）提高到 7.2 ± 2.8 METs（p = 0.01）。10 名患者（50%）的 NYHA 功能分级至少提高了 1 级，且在随访期间没有恶化。
本研究表明，尽管接受了药物治疗，但仍有症状的 HCM 患者可通过监督下的 ET 计划获得显著的功能改善。
