Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, TAIWAN.
Med Sci Sports Exerc. 2020 Feb;52(2):269-277. doi: 10.1249/MSS.0000000000002145.
Treatments that improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) have shown no benefits for those with heart failure with preserved ejection fraction (HFpEF). Our study aimed to investigate the effect of inhaled iloprost on myocardial performance during exercise in HFpEF.
The study participants were enrolled from the ILO-HOPE trial (NCT03620526), a prospective randomized, double-blind, placebo-controlled study that was designed to investigate the effects of iloprost on cardiovascular hemodynamics during exercise in patients with HFpEF. Subjects were randomized 1:1 to inhalation of iloprost or placebo for 5 min. Two-dimensional transthoracic echocardiography with high temporal resolution was implemented to measure left ventricular (LV) longitudinal strain, LV diastolic function, and RV function both at rest and during supine exercise at 20-W workload.
LV global longitudinal strain (GLS) in response to exercise increased more in the iloprost group (LV GLS, -24.96 ± 1.20 vs -20.75 ± 3.00, P < 0.001). Iloprost also resulted in greater increment of LV GLS during exercise (ΔLV GLS, +6.02 ± 1.39 vs +3.44 ± 0.80, P < 0.001). Moreover, iloprost use was associated with enhancement of LV diastolic function, RV systolic function, and relief of pulmonary hypertension during exercise.
In patients with HFpEF, inhaled iloprost favorably improved myocardial performance during exercise by increasing LV GLS reserve, decreasing LV diastolic filling load, and reducing stress-induced pulmonary hypertension and thereby improving RV systolic function. Larger studies are needed to validate the result and long-term benefits of iloprost in patients with HFpEF.
改善射血分数降低的心力衰竭（HFrEF）患者结局的治疗方法对射血分数保留的心力衰竭（HFpEF）患者没有益处。我们的研究旨在探讨吸入伊洛前列素对 HFpEF 患者运动时心肌功能的影响。
本研究参与者来自 ILO-HOPE 试验（NCT03620526），这是一项前瞻性随机、双盲、安慰剂对照研究，旨在研究伊洛前列素对 HFpEF 患者运动中心血管血液动力学的影响。受试者按 1:1 随机分为吸入伊洛前列素或安慰剂 5 分钟。采用二维经胸超声心动图和高时间分辨率，在休息和仰卧位 20-W 工作负荷下运动时，测量左心室（LV）纵向应变、LV 舒张功能和 RV 功能。
伊洛前列素组运动时 LV 整体纵向应变（GLS）的增加更为明显（LV GLS，-24.96±1.20 比-20.75±3.00，P<0.001）。伊洛前列素还导致运动时 LV GLS 的更大增量（ΔLV GLS，+6.02±1.39 比+3.44±0.80，P<0.001）。此外，伊洛前列素的使用与运动时 LV 舒张功能、RV 收缩功能的改善和肺动脉高压的缓解相关。
在 HFpEF 患者中，吸入伊洛前列素通过增加 LV GLS 储备、降低 LV 舒张充盈负荷以及降低应激诱导的肺动脉高压，从而改善 RV 收缩功能，有利于改善运动时的心肌功能。需要更大规模的研究来验证伊洛前列素在 HFpEF 患者中的疗效和长期获益。
