Pearson M J, Mungovan S F, Smart N A
School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
Westmead Private Physiotherapy Services and The Clinical Research Institute, Sydney, Australia.
Heart Fail Rev. 2017 Mar;22(2):229-242. doi: 10.1007/s10741-017-9600-0.
Diastolic dysfunction contributes to the development and progression of heart failure. Conventional echocardiography and tissue Doppler imaging are widely utilised in clinical research providing a number of indices of diastolic function valuable in the diagnosis and prognosis of heart failure patients. The aim of this meta-analysis was to quantify the effect of exercise training on diastolic function in patients with heart failure. Exercise training studies that investigate different indices of diastolic function in patients with heart failure have reported that exercise training improves diastolic function in these patients. We sought to add to the current literature by quantifying, where possible, the effect of exercise training on diastolic function. We conducted database searches (PubMed, EBSCO, EMBASE, and Cochrane Trials Register to 31 July 2016) for exercise based rehabilitation trials in heart failure, using the search terms 'exercise training, diastolic function and diastolic dysfunction'. Data from six studies, with a total of 266 heart failure with reduced ejection fraction (HFrEF) participants, 144 in intervention groups and 122 in control groups, indicated a significant reduction in the ratio of early diastolic transmitral velocity (E) to early diastolic tissue velocity (E') (E/E' ratio) with exercise training, exercise vs. control mean difference (MD) of -2.85 (95% CI -3.66 to -2.04, p < 0.00001). Data from five studies in heart failure with preserved ejection fraction (HFpEF) patients, with a total of 204 participants, 115 in intervention groups and 89 in control groups, also demonstrated a significant improvement in E/E' in exercise vs. control MD of -2.38 (95% CI -3.47 to -1.28, p < 0.0001).
舒张功能障碍会促使心力衰竭的发生和发展。传统超声心动图和组织多普勒成像在临床研究中被广泛应用，可提供多种舒张功能指标，对心力衰竭患者的诊断和预后具有重要价值。本荟萃分析的目的是量化运动训练对心力衰竭患者舒张功能的影响。关于心力衰竭患者舒张功能不同指标的运动训练研究报告称，运动训练可改善这些患者的舒张功能。我们试图通过尽可能量化运动训练对舒张功能的影响，来丰富当前的文献资料。我们进行了数据库检索（截至2016年7月31日的PubMed、EBSCO、EMBASE和Cochrane试验注册库），以查找关于心力衰竭基于运动的康复试验，检索词为“运动训练、舒张功能和舒张功能障碍”。六项研究的数据，共有266例射血分数降低的心力衰竭（HFrEF）参与者，干预组144例，对照组122例，表明运动训练后舒张早期二尖瓣血流速度（E）与舒张早期组织速度（E'）之比（E/E'比值）显著降低，运动组与对照组的平均差值（MD）为-2.85（95%可信区间-3.66至-2.04，p<0.00001）。五项关于射血分数保留的心力衰竭（HFpEF）患者的研究数据，共有204名参与者，干预组115例，对照组89例，也显示运动组与对照组相比E/E'有显著改善，MD为-2.38（95%可信区间-3.47至-1.28，p<0.0001）。
