Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
Cardiovasc Ther. 2018 Dec;36(6):e12467. doi: 10.1111/1755-5922.12467. Epub 2018 Oct 12.
Both cardiac resynchronization therapy (CRT) and Multidisciplinary Cardiac Rehabilitation (CR) beneficially influence symptomatic status, exercise capacity, quality of life, and heart failure readmission rates. However, the interaction between both therapies remain incompletely addressed.
Consecutive CRT patients implanted in a single tertiary care center were retrospectively analyzed. Patients were dived according to the participation in a structured CR-program following CRT-implant. The effect on functional status (New York Heart Association; NYHA-class), reverse remodeling (change in left ventricular ejection fraction; LVEF), and the combined endpoint of heart failure readmission and all-cause mortality was assessed after multivariate correction.
A total of 655 patients were analyzed of whom 223(34%) did and 432(66%) did not participate in a structured multidisciplinary CR-program following implant. No adverse events relating to exercise training occurred during the CR-program. Patients who participated in the CR-program had a more pronounced improvement in NYHA-class at 6-months (P = 0.006), even after multivariate correction (β = -0.144; 95% CI = [-0.270; -0.018]; P = 0.025). Maximal workload and VO2max on CPET at 6 months improved significantly even after adjustment (P < 0.001, respectively P = 0.017). At 6-months, CR associated with more improvement in LVEF (+11.9 ± 13 vs +14.5 ± 11; P = 0.008), however, this relationship was lost after multivariate correction (P = 0.136). During 36 ± 22 months follow-up, patients in the CR group had a higher event-free survival for the combined endpoint (P = 0.001), even after multivariate correction (adjusted HR = 0.547; CI = 0.366-0.818; P = 0.003).
Following CRT-implant, the participation in a structured CR-program is safe and beneficially influences symptomatic response and clinical outcome. The beneficial effects of exercise training are potentially independent and additive to the beneficial reverse remodeling effect induced by CRT itself.
心脏再同步治疗（CRT）和多学科心脏康复（CR）均有益地影响症状状态、运动能力、生活质量和心力衰竭再入院率。然而，两种治疗方法之间的相互作用仍未得到充分解决。
对在单个三级保健中心植入 CRT 的连续 CRT 患者进行回顾性分析。根据 CRT 植入后是否参加结构化 CR 计划，将患者分为两组。在多变量校正后，评估对功能状态（纽约心脏协会；NYHA 分级）、逆向重构（左心室射血分数变化；LVEF）以及心力衰竭再入院和全因死亡率的复合终点的影响。
共分析了 655 例患者，其中 223 例（34%）和 432 例（66%）在植入后未参加结构化多学科 CR 计划。在 CR 计划期间，没有与运动训练相关的不良事件发生。参加 CR 计划的患者在 6 个月时 NYHA 分级的改善更为明显（P=0.006），即使在多变量校正后（β=-0.144；95%CI=-0.270；-0.018；P=0.025）。CPET 上的最大工作量和 VO2max 在 6 个月时也显著改善，即使在调整后（P<0.001，P=0.017）。在 6 个月时，CR 与 LVEF 的改善更相关（+11.9±13 与+14.5±11；P=0.008），但在多变量校正后，这种关系消失（P=0.136）。在 36±22 个月的随访期间，CR 组的复合终点事件无事件生存率更高（P=0.001），即使在多变量校正后（校正 HR=0.547；CI=0.366-0.818；P=0.003）。
在 CRT 植入后，参加结构化的 CR 计划是安全的，并有益地影响症状反应和临床结果。运动训练的有益作用可能独立于 CRT 本身诱导的有益逆向重构作用。
