射血分数保留的心力衰竭患者静息心室-血管功能与运动能力：一项RELAX试验的辅助研究
Resting ventricular-vascular function and exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study.
作者信息
Mohammed Selma F, Borlaug Barry A, McNulty Steven, Lewis Gregory D, Lin Grace, Zakeri Rosita, Semigran Marc J, LeWinter Martin, Hernandez Adrian F, Braunwald Eugene, Redfield Margaret M
机构信息
From the Division of Cardiovascular Diseases (S.F.M., B.A.B., G.L., R.Z., M.M.R.) and Mayo Graduate School (S.F.M., R.Z.), Mayo Clinic, Rochester, MN; Duke Clinical Research Institute, Durham, NC (S.M., A.F.H.); Massachusetts General Hospital, Boston, MA (G.D.L., M.J.S.); University of Vermont, Burlington, VT (M.L.); and Harvard Medical School, Boston, MA (E.B.).
出版信息
Circ Heart Fail. 2014 Jul;7(4):580-9. doi: 10.1161/CIRCHEARTFAILURE.114.001192. Epub 2014 May 15.
BACKGROUND
Exercise intolerance is a hallmark of heart failure, but factors associated with impaired exercise capacity in heart failure with preserved ejection fraction are unclear. We hypothesized that in heart failure with preserved ejection fraction, the severity of resting ventricular and vascular dysfunction are associated with impairment in exercise tolerance as assessed by peak oxygen consumption.
METHODS AND RESULTS
Subjects with heart failure with preserved ejection fraction enrolled in the PhosphodiesteRasE-5 Inhibition to Improve CLinical Status And EXercise Capacity in Diastolic Heart Failure (RELAX) clinical trial (n=216) underwent baseline Doppler echocardiography, cardiopulmonary exercise testing, and cardiac MRI. RELAX participants were elderly (median age 69 years) and 48% were women. Ejection fraction (60%) and stroke volume (77 mL) were normal, while diastolic dysfunction (medial E/e', 16; deceleration time, 185 ms; left atrial volume, 44 mL/m(2)) and increased arterial load (arterial elastance, 1.51 mm Hg/mL) were evident. Peak oxygen consumption was reduced (11.7 mLkg(-1)min(-1), 1141 mL/min) and age, sex, body mass index, hemoglobin, and chronotropic response collectively explained 64% of the variance in raw peak oxygen consumption (mL/min). After adjustment for these variables, left ventricular structure (diastolic dimension [1.5%, P=0.008] and left ventricular mass [1.6%, P=0.008]), resting stroke volume (2.0%, P=0.002), left ventricular diastolic dysfunction (deceleration time [0.9%, P=0.03] and E/e' [1.4%, P=0.009]), and arterial function (arterial elastance [2.1%, P=0.002] and systemic arterial compliance [1.5%, P=0.007]), each explained only a small additional portion of the variance in peak oxygen consumption.
CONCLUSIONS
In heart failure with preserved ejection fraction, potentially modifiable factors (obesity, anemia, and chronotropic incompetence) are strongly associated with exercise capacity, whereas resting measures of ventricular and vascular structure and function are not.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00763867.
背景
运动耐量下降是心力衰竭的一个标志，但射血分数保留的心力衰竭患者运动能力受损的相关因素尚不清楚。我们假设，在射血分数保留的心力衰竭患者中，静息时心室和血管功能障碍的严重程度与通过峰值耗氧量评估的运动耐量受损有关。
方法和结果
参与舒张性心力衰竭磷酸二酯酶-5抑制改善临床状态和运动能力（RELAX）临床试验（n = 216）的射血分数保留的心力衰竭患者接受了基线多普勒超声心动图、心肺运动试验和心脏磁共振成像检查。RELAX试验参与者为老年人（中位年龄69岁），48%为女性。射血分数（60%）和每搏输出量（77 mL）正常，而舒张功能障碍（平均E/e'，16；减速时间，185 ms；左心房容积，44 mL/m²）和动脉负荷增加（动脉弹性，1.51 mmHg/mL）明显。峰值耗氧量降低（11.7 mL·kg⁻¹·min⁻¹，1141 mL/min），年龄、性别、体重指数、血红蛋白和变时反应共同解释了原始峰值耗氧量（mL/min）变异的64%。在对这些变量进行校正后，左心室结构（舒张末期内径[1.5%，P = 0.008]和左心室质量[1.6%，P = 0.008]）、静息每搏输出量（2.0%，P = 0.002）、左心室舒张功能障碍（减速时间[0.9%，P = 0.03]和E/e'[1.4%，P = 0.009]）以及动脉功能（动脉弹性[2.1%，P = 0.002]和全身动脉顺应性[1.5%，P = 0.007]），各自仅解释了峰值耗氧量变异中一小部分额外变异。
结论
在射血分数保留的心力衰竭患者中，潜在可改变的因素（肥胖、贫血和变时功能不全）与运动能力密切相关，而心室和血管结构及功能的静息指标则不然。
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