Nolte Kathleen, Schwarz Silja, Gelbrich Götz, Mensching Steffen, Siegmund Friederike, Wachter Rolf, Hasenfuss Gerd, Düngen Hans-Dirk, Herrmann-Lingen Christoph, Halle Martin, Pieske Burkert, Edelmann Frank
Department of Cardiology, University of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany.
Department of Prevention, Rehabilitation and Sports Medicine, Munich & German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Technische Universität München, Georg-Brauchle-Ring 56 (Campus C), D-80992, Munich, Germany.
ESC Heart Fail. 2014 Sep;1(1):59-74. doi: 10.1002/ehf2.12007.
The long-term effects of exercise training (ET) in diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF) are unknown. The present study compared the long-term effects of ET on exercise capacity, diastolic function, and quality of life (QoL) in patients with DD vs. HFpEF.
A total of n = 43 patients with asymptomatic DD (n = 19) or HFpEF [DD and New York Heart Association (NYHA) ≥II, n = 24] and left ventricular ejection fraction ≥50% performed a combined endurance/resistance training over 6 months (2-3/week) on top of usual care. Cardiopulmonary exercise testing, echocardiography, and QoL were obtained at baseline and follow-up.
Patients were 62 ± 8 years old (37% female). In the HFpEF group, 67% of patients were in NYHA class II (33% in NYHA III). Exercise capacity (peak oxygen consumption, peak VO ) differed at baseline (DD 29.2 ± 8.7 mL/min/kg vs. HFpEF 17.8 ± 4.6 mL/min/kg; P = 0.004). After 6 months, peak VO increased significantly (P < 0.044) to 19.7 ± 5.8 mL/min/kg in the HFpEF group and also in the DD group (to 32.8 ± 8.5 mL/min/kg; P < 0.002) with no overall difference between the groups (P = 0.217). E/e' ratio (left ventricular filling index) decreased from 12.2 ± 3.5 to 10.1 ± 3.0 (P < 0.002) in patients with HFpEF and also in patients with DD (10.7 ± 3.1 vs. 9.5 ± 2.3; P = 0.03; difference between groups P = 0.210). In contrast, left atrial volume index decreased in the HFpEF group (P < 0.001) but remained stable within the DD group (difference between groups P = 0.015). After 6 months, physical QoL (Minnesota living with heart failure Questionnaire, 36-item short form health survey), general health perception, and 9-item patient health questionnaire score only improved in HFpEF (P < 0.05). In contrast, vitality improved in both groups (difference between groups P = 0.708).
A structured 6 months ET programme effectively improves exercise capacity and diastolic function in patients with DD and overt HFpEF. Therefore, controlled lifestyle modification with physical activity is effective both in DD and HFpEF.
运动训练（ET）对舒张功能障碍（DD）和射血分数保留的心力衰竭（HFpEF）的长期影响尚不清楚。本研究比较了ET对DD患者与HFpEF患者运动能力、舒张功能和生活质量（QoL）的长期影响。
共有n = 43例无症状DD患者（n = 19）或HFpEF患者[DD且纽约心脏协会（NYHA）≥II级，n = 24]，左心室射血分数≥50%，在常规治疗基础上进行为期6个月（每周2 - 3次）的耐力/阻力联合训练。在基线和随访时进行心肺运动测试、超声心动图检查和QoL评估。
患者年龄为62±8岁（37%为女性）。在HFpEF组中，67%的患者为NYHA II级（33%为NYHA III级）。运动能力（峰值耗氧量，峰值VO）在基线时存在差异（DD组为29.2±8.7 mL/min/kg，HFpEF组为17.8±4.6 mL/min/kg；P = 0.004）。6个月后，HFpEF组的峰值VO显著增加（P < 0.044）至19.7±5.8 mL/min/kg，DD组也显著增加（至32.8±8.5 mL/min/kg；P < 0.002），两组之间无总体差异（P = 0.217）。HFpEF患者和DD患者的E/e'比值（左心室充盈指数）均从12.2±
