Piotrowicz Ewa, Piotrowski Walerian, Piotrowicz Ryszard
Institute of Cardiology, Telecardiology Center, Warsaw, Poland.
Statistics Laboratory, Institute of Cardiology, Warsaw, Poland.
Ann Noninvasive Electrocardiol. 2016 Jul;21(4):358-68. doi: 10.1111/anec.12320. Epub 2015 Nov 2.
Autonomic nervous system (ANS) dysfunction appears in the course of both chronic heart failure (CHF) and depression. Comprehensive cardiac rehabilitation (CCR), apart from improving physical capacity, can reduce depressive symptoms and leads to the restoration of ANS function among CHF patients. The purpose was to evaluate the influence of the reversion of depression (measured by Beck Depression Inventory [BDI] score, cut point <10) and the physical capacity improvement (measured by peak oxygen consumption [peak VO2 ; ml/kg per minute]) on the sympathovagal balance (measured by low/high frequency ratio [LF/HF]) after CCR in CHF patients.
The study group comprised 111 CHF patients (New York Heart Association II-III; left ventricular ejection fraction ≤ 40%). Patients were randomized (2:1) to 8-week CCR based on Nordic walking training (five times weekly) at 40-70% of maximal heart rate, training group (TG) n = 77, or to control group (CG) n = 34. The effectiveness of CCR was assessed by changes-delta (Δ) in LF/HF, BDI score, and peak VO2 , as a result of comparing these parameters from the beginning and the end of the program.
Eventually, 46 patients in TG and 23 patients in CG were eligible for simultaneous ANS and psychological status analysis. Only in TG the LF/HF decreased 2.06 ± 1.14 versus 1.19 ± 0.80 (P < 0.0001) and peak VO2 increased 16.83 ± 3.72 versus 19.14 ± 4.20 ml/kg per minute (P < 0.0001). Favorable results in CG were not observed. The differences between TG and CG were significant: Δpeak VO2 (P < 0.0001); ΔLF/HF (P = 0.0001). Depressive symptoms were substantially reduced in both groups (TG, P = 0.0006; CG, P = 0.0490). Nevertheless, the greatest improvement of sympathovagal balance was observed in patients whose depression was reversed, thanks to the CCR in comparison to other patients from TG and the entire CG.
Positive effect of the sympatho-parasympathetic balance obtained during the home CCR based on Nordic walking training results from the additive effects of the reversion of depression and physical capacity improvement in CHF patients.
自主神经系统（ANS）功能障碍在慢性心力衰竭（CHF）和抑郁症病程中均会出现。综合心脏康复（CCR）除了能改善身体机能外，还可减轻抑郁症状，并使CHF患者的ANS功能得以恢复。本研究旨在评估CHF患者经CCR治疗后，抑郁症状的改善（以贝克抑郁量表[BDI]评分衡量，分界点<10）及身体机能的提升（以峰值耗氧量[peak VO2；毫升/千克每分钟]衡量）对交感迷走神经平衡（以低频/高频比值[LF/HF]衡量）的影响。
研究组包括111例CHF患者（纽约心脏协会心功能II - III级；左心室射血分数≤40%）。患者按2:1随机分为两组，一组接受为期8周基于北欧健走训练（每周5次）的CCR，训练强度为最大心率的40 - 70%，即训练组（TG），n = 77；另一组为对照组（CG），n = 34。通过比较项目开始和结束时LF/HF、BDI评分及peak VO2的变化差值（Δ）来评估CCR的效果。
最终，TG组46例患者和CG组23例患者符合同时进行ANS和心理状态分析的条件。仅在TG组中，LF/HF降低，从2.06±1.14降至1.19±0.80（P < 0.0001），peak VO2升高，从16.83±3.72升至19.14±4.20毫升/千克每分钟（P < 0.0001）。CG组未观察到良好效果。TG组和CG组之间的差异显著：Δpeak VO2（P < 0.0001）；ΔLF/HF（P = 0.0001）。两组抑郁症状均显著减轻（TG组，P = 0.0006；CG组，P = 0.0490）。然而，与TG组其他患者及整个CG组相比，经CCR治疗后抑郁症状得到改善的患者交感迷走神经平衡改善最为明显。
基于北欧健走训练的家庭CCR过程中获得的交感 - 副交感神经平衡的积极效果，源于CHF患者抑郁症状改善和身体机能提升的叠加效应。
