Aslanger Emre, Assous Benjamin, Bihry Nicolas, Beauvais Florence, Logeart Damien, Cohen-Solal Alain
Department of Cardiology, Department of Cardiology, Yeditepe University Hospital, Ataşehir, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (E.A., B.A., N.B.).
Lariboisière Hospital, Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), UMR-S 942, Université Paris Diderot, DHU FIRE, Paris, France (F.B., D.L., A.C.S.).
J Am Heart Assoc. 2015 Oct 13;4(10):e002084. doi: 10.1161/JAHA.115.002084.
Success of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular-arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX-derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.
Thirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise-based CR. Noninvasive LV pressure-volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO2 was not in a significant correlation with the change in VAC (r=-0.18; P=0.31), mechanical efficiency (r=-0.16, P=0.39), or the change in ejection fraction (r=-0.07; P=0.68).
CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX-derived data in predicting clinical outcomes.
心脏康复（CR）的成功通常通过心肺运动试验（CPX）测量的吸入氧峰值容积（VO2）的客观改善来评估。然而，心脏机械效率和心室-动脉耦联（VAC）是心力衰竭病理生理学的其他重要方面，这些并未包含在CPX得出的数据中。迄今为止，尚未研究心脏康复对未选择的心力衰竭患者左心室（LV）效率或VAC的影响。
招募了30名射血分数≤45%的患者进行为期20节的基于运动的CR。构建无创左心室压力-容积环，并在CR前后借助压平眼压计和超声心动图计算VAC。VAC显示机械效率曲线改善，且从0.56±0.18显著增加至0.67±0.21（P = 0.02）。左心室机械效率从43.9±9.1%提高到48.8±9.1%（P = 0.01）。VO2峰值的变化与VAC的变化（r = -0.18；P = 0.31）、机械效率（r = -0.16，P = 0.39）或射血分数的变化（r = -0.07；P = 0.68）均无显著相关性。
CR与心力衰竭患者VAC和左心室机械效率的改善相关。需要进一步研究以确定VAC和机械效率相对于CPX得出的数据在预测临床结局方面的增量价值。
