Yamauchi Fumitake, Adachi Hitoshi, Tomono Jun-Ichi, Toyoda Shigeru, Iwamatsu Koichi, Sakuma Masashi, Nakajima Toshiaki, Oshima Shigeru, Inoue Teruo
Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
Heart Vessels. 2016 Oct;31(10):1659-68. doi: 10.1007/s00380-015-0782-x. Epub 2015 Dec 19.
Although exercise oscillatory ventilation has emerged as a potent independent risk factor for adverse prognosis in heart failure, it is not well known whether cardiac rehabilitation can improve oscillatory ventilation. In this study, we investigated the magnitude of oscillations in ventilation before and after cardiac rehabilitation in chronic heart failure patients with exercise oscillatory ventilation. Cardiac rehabilitation (5-month program) was performed in 26 patients with chronic heart failure who showed an oscillatory ventilation pattern during cardiopulmonary exercise testing (CPX). After the 5-month rehabilitation program was completed, the patients again underwent CPX. To determine the magnitude of oscillations in ventilation, the amplitude and cycle length of the oscillations were calculated and compared with several other parameters, including biomarkers that have established prognostic value in heart failure. At baseline before cardiac rehabilitation, both oscillation amplitude (R = 0.625, P < 0.01) and cycle length (R = 0.469, P < 0.05) were positively correlated with the slope of minute ventilation vs. carbon dioxide production. Plasma BNP levels were positively correlated with amplitude (R = 0.615, P < 0.01) but not cycle length (R = 0.371). Cardiac rehabilitation decreased oscillation amplitude (P < 0.01) but failed to change cycle length. The change in amplitude was positively correlated with the change in BNP levels (R = 0.760, P < 0.01). Multiple regression analysis showed that only the change in amplitude was an independent predictor of the change in BNP levels (R = 0.717, P < 0.01). A 5-month cardiac rehabilitation program improves exercise oscillatory ventilation in chronic heart failure patients by reducing the oscillation amplitude. This effect is associated with a reduction of plasma BNP levels, potentially contributing to an improvement of heart failure.
尽管运动振荡通气已成为心力衰竭不良预后的一个强大独立危险因素，但心脏康复是否能改善振荡通气尚不清楚。在本研究中，我们调查了运动振荡通气的慢性心力衰竭患者在心脏康复前后通气振荡的幅度。对26例在心肺运动试验（CPX）期间表现出振荡通气模式的慢性心力衰竭患者进行了心脏康复（为期5个月的项目）。在完成5个月的康复项目后，患者再次接受CPX。为了确定通气振荡的幅度，计算了振荡的幅度和周期长度，并与其他几个参数进行了比较，包括在心力衰竭中已确立预后价值的生物标志物。在心脏康复前的基线时，振荡幅度（R = 0.625，P < 0.01）和周期长度（R = 0.469，P < 0.05）均与分钟通气量与二氧化碳产生量的斜率呈正相关。血浆脑钠肽（BNP）水平与幅度呈正相关（R = 0.615，P < 0.01），但与周期长度无关（R = 0.371）。心脏康复降低了振荡幅度（P < 0.01），但未能改变周期长度。幅度的变化与BNP水平的变化呈正相关（R = 0.760，P < 0.01）。多元回归分析表明，只有幅度的变化是BNP水平变化的独立预测因子（R = 0.717，P < 0.01）。一个为期5个月的心脏康复项目通过降低振荡幅度改善了慢性心力衰竭患者的运动振荡通气。这种效应与血浆BNP水平的降低有关，可能有助于心力衰竭的改善。
