Trippel Tobias Daniel, Holzendorf Volker, Halle Martin, Gelbrich Götz, Nolte Kathleen, Duvinage Andre, Schwarz Silja, Rutscher Tinka, Wiora Julian, Wachter Rolf, Herrmann-Lingen Christoph, Duengen Hans-Dirk, Hasenfuß Gerd, Pieske Burkert, Edelmann Frank
Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany.
ZKS Leipzig (Clinical Trial Centre Leipzig) University of Leipzig Leipzig Germany.
ESC Heart Fail. 2017 Feb;4(1):56-65. doi: 10.1002/ehf2.12109. Epub 2016 Aug 31.
Over 50% of patients with symptomatic heart failure (HF) experience HF with preserved ejection fraction (HFpEF) Exercise training (ET) is effective in improving cardiorespiratory fitness and dimensions of quality of life in patients with HFpEF. A systemic pro-inflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations has been proposed in HFpEF. ET modifies myocardial structure and has been related to inflammatory state. We investigated Ghrelin, related adipokines, markers of inflammation, and neuro-hormonal activation in patients undergoing a structured ET vs. usual care are with HFpEF
Ex-DHF-P was a prospective, controlled, randomized multi-centre trial on structured and supervised ET in patients with HFpEF. We performed a analysis in 62 patients from Ex-DHF-P. Ghrelin, adiponectin, leptin, IL-1, IL-6, IL-10, tumour necrosis factor-alpha, MR-proANP, MR-proADM, CT-proET1, and CT-proAVP were assessed to seize the impact of ET on these markers in patients with HFpEF. Thirty-six (58%) patients were female, mean age was 64 years, and median ghrelin was 928 pg/mL (interquartile range 755-1156). When stratified for high versus low ghrelin, groups significantly differed at baseline in presence obesity, waist circumference, and adiponectin levels ( < 0.05, respectively). Overall, ghrelin levels rose significantly to 1013 pg/mL (interquartile range 813-1182) ( < 0.001). Analysis of covariance modelling for change in ghrelin identified ET ( = 0.013) and higher baseline adiponectin levels ( = 0.035) as influencing factors.
Exercise training tended to increase ghrelin levels in Ex-DHF-P. This increase was especially pronounced in patients with higher baseline adiponectin levels. Future trials are needed to investigate the effect of ET on endogenous ghrelin levels in regard to interactions with cardiac structure and clinically meaningful surrogate parameters.
超过50%的有症状心力衰竭（HF）患者经历射血分数保留的心力衰竭（HFpEF）。运动训练（ET）对改善HFpEF患者的心肺适应性和生活质量维度有效。有人提出，合并症诱导的全身促炎状态是HFpEF中心肌结构和功能改变的原因。ET可改变心肌结构，并与炎症状态有关。我们研究了接受结构化ET与常规治疗的HFpEF患者的胃饥饿素、相关脂肪因子、炎症标志物和神经激素激活情况。
Ex-DHF-P是一项针对HFpEF患者进行结构化和监督性ET的前瞻性、对照、随机多中心试验。我们对Ex-DHF-P的62例患者进行了分析。评估了胃饥饿素、脂联素、瘦素、白细胞介素-1、白细胞介素-6、白细胞介素-10、肿瘤坏死因子-α、中段心房利钠肽前体（MR-proANP）、中段肾上腺髓质素前体（MR-proADM）、C末端前内皮素-1（CT-proET1）和C末端前血管加压素（CT-proAVP），以了解ET对HFpEF患者这些标志物的影响。36例（58%）患者为女性，平均年龄64岁，胃饥饿素中位数为928 pg/mL（四分位间距755 - 1156）。按胃饥饿素水平高低分层时，两组在基线时肥胖、腰围和脂联素水平方面存在显著差异（P分别<0.05）。总体而言，胃饥饿素水平显著升至1013 pg/mL（四分位间距813 - 1182）（P<0.001）。胃饥饿素变化的协方差分析模型确定ET（P = 0.013）和较高的基线脂联素水平（P = 0.035）为影响因素。
在Ex-DHF-P中，运动训练倾向于提高胃饥饿素水平。这种升高在基线脂联素水平较高的患者中尤为明显。未来需要进行试验，以研究ET对内源性胃饥饿素水平的影响及其与心脏结构和具有临床意义的替代参数的相互作用。
