Tzanis Georgios, Manetos Christos, Dimopoulos Stavros, Vasileiadis Ioannis, Malliaras Kostas, Kaldara Elisabeth, Karatzanos Eleftherios, Nanas Serafim
1st Critical Care Medicine Department (Drs Tzanis, Manetos, Dimopoulos, Vasileiadis, Karatzanos, and Nanas), Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidion Hospital, NKUA, Athens, Greece; and 3rd Cardiology Department (Drs Malliaras and Kaldara), NKUA, Athens, Greece.
J Cardiopulm Rehabil Prev. 2016 Jan-Feb;36(1):33-7. doi: 10.1097/HCR.0000000000000145.
Exercise training programs improve microcirculatory alternations in patients with chronic heart failure (CHF). However less is known about the acute effect of maximum exercise on the skeletal muscle microcirculation. We aimed to assess the effect of acute exercise on peripheral microcirculation of patients with CHF, as assessed by near-infrared spectroscopy with vascular occlusion technique.
Tissue oxygenation was evaluated in 8 stable patients with CHF (7 males; mean age, 60 ± 9 years; body mass index, 26.3 ± 3.8 kg/m) and 8 healthy subjects (matched for age, sex, and body mass index) before and after cardiopulmonary exercise testing. Tissue oxygen saturation (StO2), StO2peak, oxygen consumption rate, and endothelial function (reperfusion rate), before and after maximum exercise, were assessed.
Patients with CHF had lower StO2 and reperfusion rate compared with healthy subjects (71.4% ± 9.8% vs 81.0% ± 5.4% and 9 ± 1 %/min vs 13.9 ± 5.8%/min, respectively; P < .05) at rest. Oxygen consumption rate increased after exercise in patients with CHF and healthy subjects (from -31.7 ± 8.2 to -43.7 ± 12.7 and from -35.7 ± 6.7 to -42.4 ± 6.4, respectively; P < .05). StO2 decreased significantly after maximal exercise in patients with CHF (from 71.4 ± 9.8 to 65.2 ± 12.7; P < .05), whereas it returned to the preexercise values in healthy subjects (from 81.0 ± 5.4 to 80.3 ± 7.0). There was a significant between-group difference (P < .05).
Patients with CHF present microcirculatory alternations. Acute exercise exerts an effect on microcirculation in peripheral, nonexercising muscles, with altered response in patients with CHF compared with healthy subjects.
运动训练计划可改善慢性心力衰竭（CHF）患者的微循环改变。然而，关于最大运动对骨骼肌微循环的急性影响知之甚少。我们旨在通过采用血管闭塞技术的近红外光谱法评估急性运动对CHF患者外周微循环的影响。
对8例稳定的CHF患者（7例男性；平均年龄60±9岁；体重指数26.3±3.8kg/m）和8名健康受试者（年龄、性别和体重指数匹配）在心肺运动试验前后进行组织氧合评估。评估最大运动前后的组织氧饱和度（StO2）、StO2峰值、氧消耗率和内皮功能（再灌注率）。
在静息状态下，CHF患者的StO2和再灌注率低于健康受试者（分别为71.4%±9.8%对81.0%±5.4%以及9±1%/分钟对13.9±5.8%/分钟；P<.05）。CHF患者和健康受试者运动后氧消耗率均增加（分别从-31.7±8.2增加至-43.7±12.7以及从-35.7±6.7增加至-42.4±6.4；P<.05）。CHF患者在最大运动后StO2显著降低（从71.4±9.8降至65.2±12.7；P<.05），而健康受试者的StO2恢复至运动前水平（从81.0±5.4降至80.3±7.0）。组间差异有统计学意义（P<.05）。
CHF患者存在微循环改变。急性运动对外周非运动肌肉的微循环有影响，与健康受试者相比，CHF患者的反应有所改变。
