Bajraktari Gani, Kurtishi Ilir, Rexhepaj Nehat, Tafarshiku Rina, Ibrahimi Pranvera, Jashari Fisnik, Alihajdari Rrezarta, Batalli Arlind, Elezi Shpend, Henein Michael Y
Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Sweden.
Int J Cardiol Heart Vessel. 2013 Oct 3;1:11-16. doi: 10.1016/j.ijchv.2013.09.001. eCollection 2013 Dec.
The aim of this study was to investigate the impact of gender on the prediction of limited exercise capacity in heart failure (HF) patients assessed by 6 minute walk test (6-MWT).
In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and a Doppler echocardiographic study were performed in the same day. Conventional cardiac measurements were obtained and global LV dyssynchrony was indirectly assessed using total isovolumic time - t-IVT [in s/min; calculated as: 60 - (total ejection time - total filling time)] and Tei index (t-IVT/ejection time). Patients were divided into two groups according to gender, which were again divided into two subgroups based on the 6-MWT distance (Group I: ≤ 300 m, and Group II: > 300 m).
Female patients were younger (p = 0.02), and had higher left ventricular (LV) ejection fraction - EF (p = 0.007) but with similar 6-MWT distance to male patients (p = 68). Group I male patients had lower hemoglobin level (p = 0.02) and lower EF (p = 0.03), compared with Group II, but none of the clinical or echocardiographic variables differed between groups in female patients. In multivariate analysis, only t-IVT [0.699 (0.552-0.886), p = 0.003], and LV EF [0.908 (0.835-0.987), p = 0.02] in males, and NYHA functional class [4.439 (2.213-16.24), p = 0.02] in females independently predicted poor 6-MWT distance (< 300 m).
Despite similar limited exercise capacity, gender determines the pattern of underlying cardiac disturbances; ventricular dysfunction in males and subjective NYHA class in female heart failure patients.
本研究旨在探讨性别对通过6分钟步行试验（6-MWT）评估的心力衰竭（HF）患者运动能力受限预测的影响。
对147例HF患者（平均年龄61±11岁，男性占50.3%）在同一天进行6-MWT和多普勒超声心动图检查。获取常规心脏测量值，并使用总等容时间-t-IVT[单位为秒/分钟；计算方法为：60-（总射血时间-总充盈时间）]和Tei指数（t-IVT/射血时间）间接评估左心室整体不同步性。患者按性别分为两组，再根据6-MWT距离分为两个亚组（I组：≤300米，II组：>300米）。
女性患者年龄较小（p=0.02），左心室（LV）射血分数-EF较高（p=0.007），但6-MWT距离与男性患者相似（p=0.68）。与II组相比，I组男性患者血红蛋白水平较低（p=0.02），EF较低（p=0.03），但女性患者组间临床或超声心动图变量无差异。多因素分析中，仅男性的t-IVT[0.699（0.552-0.886），p=0.003]和LV EF[0.908（0.835-0.987），p=0.02]以及女性的纽约心脏协会（NYHA）功能分级[4.439（2.213-16.24），p=0.02]独立预测6-MWT距离较差（<300米）。
尽管运动能力受限情况相似，但性别决定了潜在心脏紊乱的模式；男性为心室功能障碍，女性心力衰竭患者为NYHA主观分级。
