Esfandiari Sam, Wright Stephen P, Goodman Jack M, Sasson Zion, Mak Susanna
1Institute of Medical Science, University of Toronto, Toronto, CANADA; 2Division of Cardiology, Mount Sinai Hospital/University Health Network, Toronto, CANADA; and 3Department of Exercise Sciences, University of Toronto, Toronto, CANADA.
Med Sci Sports Exerc. 2017 Jul;49(7):1297-1304. doi: 10.1249/MSS.0000000000001227.
An augmented pulmonary artery wedge pressure (PAWP) response may explain exercise intolerance in some humans. However, routine use of exercise hemodynamic testing is limited by a lack of data from normal older men and women. Our objective was to evaluate the exercise PAWP response and the potential for sexual dimorphism in healthy, nondyspneic older adults.
Thirty-six healthy volunteers (18 men [54 ± 7 yr] and 18 women [58 ± 6 yr]) were studied at rest (control) and during two stages of semi-upright cycle ergometry, at heart rates of 100 bpm (light exercise) and 120 bpm (moderate exercise). Right heart catheterization was performed to measure pulmonary pressures. The PAWP response to exercise was assessed in context of exercise work rate and body size.
At control, PAWP was similar between men and women. Work rates were significantly smaller in women at comparable HR (P < 0.001). PAWP increased similarly at light exercise, with no further increase at moderate exercise. When indexed to work rate alone or work rate adjusted to body weight and height, the PAWP response at light and moderate exercise was significantly elevated in women compared with men (P < 0.05 condition-sex interaction). The change in PAWP relative to the increase in cardiac output did not exceed 2 mm Hg·L·min in any volunteer at moderate exercise.
The similar rise in the PAWP response to submaximal exercise occurs despite lower work rate in healthy older women compared with men, even when adjusted for smaller body size. It is important to consider sex in the development of normal reference ranges for exercise hemodynamic testing.
肺动脉楔压（PAWP）反应增强可能解释部分人的运动不耐受情况。然而，常规运动血流动力学检测的应用因缺乏正常老年男性和女性的数据而受限。我们的目的是评估健康、无呼吸困难的老年人运动时的PAWP反应以及存在性别差异的可能性。
对36名健康志愿者（18名男性[54±7岁]和18名女性[58±6岁]）进行静息状态（对照）以及半直立式蹬车测力的两个阶段研究，心率分别为100次/分钟（轻度运动）和120次/分钟（中度运动）。进行右心导管插入术以测量肺压力。在运动做功率和体型的背景下评估PAWP对运动的反应。
在对照状态下，男性和女性的PAWP相似。在相同心率时，女性的做功率显著较小（P<0.001）。在轻度运动时PAWP的增加相似，在中度运动时没有进一步增加。当仅根据做功率或根据体重和身高调整后的做功率进行校正时，与男性相比，女性在轻度和中度运动时的PAWP反应显著升高（P<0.05，状态-性别交互作用）。在中度运动时，任何志愿者的PAWP相对于心输出量增加的变化均未超过2mmHg·L·min。
尽管健康老年女性与男性相比做功率较低，但即使考虑到体型较小，在次最大运动时PAWP反应的升高仍相似。在制定运动血流动力学检测的正常参考范围时考虑性别很重要。
