Omar Wally, Pandey Ambarish, Haykowsky Mark J, Berry Jarett D, Lavie Carl J
Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.
Curr Heart Fail Rep. 2018 Apr;15(2):75-80. doi: 10.1007/s11897-018-0382-z.
This paper highlights the dynamic relationship between cardiorespiratory fitness (CRF) and heart failure (HF). As heart failure with preserved ejection fraction (HFpEF) surpasses heart failure with reduced ejection fraction (HFrEF) in prevalence, our void in understanding how to treat this syndrome becomes less justifiable. As such, significant attention has been given to the role that obesity and physical inactivity play, as both risk factors for heart failure, and therapeutic targets for its treatment.
Previous findings have shown that low CRF, obesity, and physical inactivity are all risk factors for HF. More recently, it has been discovered that these factors are even more significant when applied to HFpEF, even after accounting for traditional cardiovascular risk factors. As such, new investigations have attempted to discover whether improvements in CRF could be utilized as a tool for prevention of HF. In addition, small studies have shown that interventions to improve CRF in patients with HF could improve both quality of life and fitness. The role of CRF, PA, and obesity in the development of HF is now well established; however, our ability to attenuate that risk is yet to be determined. Observational data have signaled a correlation between improvements in PA, CRF and lower risk of HF however, large randomized controlled trials are still required to truly determine whether exercise training could be used in the prevention and treatment of HF, particularly HFpEF.
本文重点阐述心肺适能（CRF）与心力衰竭（HF）之间的动态关系。随着射血分数保留的心力衰竭（HFpEF）在患病率上超过射血分数降低的心力衰竭（HFrEF），我们在理解如何治疗该综合征方面的空白变得愈发不合理。因此，肥胖和身体活动不足作为心力衰竭的危险因素以及治疗靶点所起的作用受到了极大关注。
既往研究结果表明，低心肺适能、肥胖和身体活动不足均为心力衰竭的危险因素。最近发现，即便考虑了传统心血管危险因素，这些因素在应用于射血分数保留的心力衰竭时影响更为显著。因此，新的研究试图探寻改善心肺适能是否可作为预防心力衰竭的一种手段。此外，小型研究表明，对心力衰竭患者进行改善心肺适能的干预可提高生活质量和适能。心肺适能、身体活动和肥胖在心力衰竭发生发展中的作用现已明确；然而，我们降低该风险的能力尚待确定。观察性数据表明身体活动、心肺适能的改善与较低的心力衰竭风险之间存在关联，不过仍需要大型随机对照试验来真正确定运动训练是否可用于预防和治疗心力衰竭，尤其是射血分数保留的心力衰竭。
