Brinker Stephanie K, Pandey Ambarish, Ayers Colby R, Barlow Carolyn E, DeFina Laura F, Willis Benjamin L, Radford Nina B, Farzaneh-Far Ramin, de Lemos James A, Drazner Mark H, Berry Jarett D
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
The Cooper Institute, Dallas, Texas.
JACC Heart Fail. 2014 Jun;2(3):238-46. doi: 10.1016/j.jchf.2014.01.004. Epub 2014 Apr 30.
This study sought to compare the cross-sectional associations between fitness and echocardiographic measures of cardiac structure and function.
Cardiorespiratory fitness is inversely associated with heart failure risk. However, the mechanism through which fitness lowers heart failure risk is not fully understood.
We included 1,678 men and 1,247 women from the Cooper Center Longitudinal Study who received an echocardiogram from 1999 to 2011. Fitness was estimated by Balke protocol (in metabolic equivalents) and also categorized into age-specific quartiles, with quartile 1 representing low fitness. Cross-sectional associations between fitness (in metabolic equivalents) and relative wall thickness, left ventricular end-diastolic diameter indexed to body surface area, left atrial volume indexed to body surface area, left ventricular systolic function, and E/e' ratio were determined using multivariable linear regression analysis.
Higher levels of mid-life fitness (metabolic equivalents) were associated with larger indexed left atrial volume (men: beta = 0.769, p < 0.0001; women: beta = 0.879, p value ≤0.0001) and indexed left ventricular end-diastolic diameter (men: beta = 0.231, p < 0.001; women: beta = 0.264, p < 0.0001). Similarly, a higher level of fitness was associated with a smaller relative wall thickness (men: beta = -0.002, p = 0.04; women: beta = -0.005, p < 0.0001) and E/e' ratio (men: beta = -0.11, p = 0.003; women: beta = -0.13, p = 0.01). However, there was no association between low fitness and left ventricular systolic function (p = NS).
Low fitness is associated with a higher prevalence of concentric remodeling and diastolic dysfunction, suggesting that exercise may lower heart failure risk through its effect on favorable cardiac remodeling and improved diastolic function.
本研究旨在比较体能与心脏结构和功能的超声心动图测量指标之间的横断面关联。
心肺适能与心力衰竭风险呈负相关。然而，体能降低心力衰竭风险的机制尚未完全明确。
我们纳入了库珀中心纵向研究中的1678名男性和1247名女性，这些人在1999年至2011年间接受了超声心动图检查。通过巴尔克运动试验方案（以代谢当量计）评估体能，并将其分为特定年龄的四分位数，其中第一四分位数代表低体能。使用多变量线性回归分析确定体能（以代谢当量计）与相对室壁厚度、体表面积指数化的左心室舒张末期内径、体表面积指数化的左心房容积、左心室收缩功能以及E/e'比值之间的横断面关联。
中年体能水平较高（代谢当量）与体表面积指数化的左心房容积较大相关（男性：β = 0.769，p < 0.0001；女性：β = 0.879，p值≤0.0001）以及体表面积指数化的左心室舒张末期内径较大相关（男性：β = 0.231，p < 0.001；女性：β = 0.264，p < 0.0001）。同样，较高的体能水平与较小的相对室壁厚度（男性：β = -0.002，p = 0.04；女性：β = -0.005，p < 0.0001）和E/e'比值相关（男性：β = -0.11，p = 0.003；女性：β = -0.13，p = 0.01）。然而，低体能与左心室收缩功能之间无关联（p = 无显著性差异）。
低体能与向心性重塑和舒张功能障碍的较高患病率相关，提示运动可能通过其对有利的心脏重塑和改善舒张功能的作用来降低心力衰竭风险。
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