Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia.
JACC Heart Fail. 2019 Apr;7(4):321-332. doi: 10.1016/j.jchf.2019.01.006. Epub 2019 Mar 6.
This study sought to discern which central (e.g., heart rate, stroke volume [SV], filling pressure) and peripheral factors (e.g., oxygen use by skeletal muscle, body mass index [BMI]) during exercise were most strongly associated with the presence of heart failure and preserved ejection fraction (HFpEF) as compared with healthy control subjects exercising at the same workload.
The underlying mechanisms limiting exercise capacity in patients with HFpEF are not fully understood.
In patients with HFpEF (n = 108), the hemodynamic response at peak exercise was measured using right-sided heart catheterization and was compared with that in healthy control subjects (n = 42) at matched workloads to reveal hemodynamic differences that were not attributable to the workload performed. The patients studied were prospectively included in the REDUCE-LAP HF (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) trials and HemReX (Effect of Age on the Hemodynamic Response During Rest and Exercise in Healthy Humans) study. Univariable and multivariable logistic regression models were used to analyze variables associated with HFpEF versus control subjects.
Compared with healthy control subjects, pulmonary capillary wedge pressure (PCWP) and SV were the only independent hemodynamic variables that were associated with HFpEF, a finding explaining 66% (p < 0.0001) of the difference between the groups. When relevant baseline characteristics were added to the base model, only BMI emerged as an additional independent variable, in total explaining of 90% of the differences between groups (p < 0.0001): PCWP (47%), BMI (31%), and SV (12%).
The study identified 3 key variables (PCWP, BMI, and SV) that independently correlate with the presence of patients with HFpEF compared with healthy control subjects exercising at the same workload. Therapies that decrease left-sided heart filling pressures could improve exercise capacity and possibly prognosis.
本研究旨在探究在进行相同运动负荷的情况下，与健康对照者相比，哪些中心（如心率、每搏量[SV]、充盈压）和外周因素（如骨骼肌耗氧量、体重指数[BMI]）与心力衰竭伴射血分数保留（HFpEF）的存在关系最为密切。
HFpEF 患者运动能力受限的潜在机制尚未完全阐明。
对 108 例 HFpEF 患者在达到峰值运动时进行右心导管检查，以测量其血流动力学反应，并与 42 例健康对照者在匹配的运动负荷下进行比较，以揭示不是由于所完成的运动负荷引起的血流动力学差异。研究患者前瞻性地纳入 REDUCE-LAP HF（降低心力衰竭患者左心房压力）试验和 HemReX（健康人类在休息和运动期间年龄对血流动力学反应的影响）研究。采用单变量和多变量逻辑回归模型分析与 HFpEF 患者与对照组相关的变量。
与健康对照组相比，肺毛细血管楔压（PCWP）和 SV 是唯一与 HFpEF 相关的独立血流动力学变量，这一发现解释了两组之间差异的 66%（p<0.0001）。当将相关基线特征添加到基本模型中时，仅 BMI 成为另一个独立变量，总共解释了组间差异的 90%（p<0.0001）：PCWP（47%）、BMI（31%）和 SV（12%）。
该研究确定了 3 个关键变量（PCWP、BMI 和 SV），与在相同运动负荷下进行运动的 HFpEF 患者存在独立相关。降低左心充盈压的治疗方法可能会改善运动能力和预后。
