Department of Cardiology and Internal Medicine, Military Institute of Medicine, Warsaw, Poland.
J Hum Hypertens. 2021 Jul;35(7):613-620. doi: 10.1038/s41371-020-0373-x. Epub 2020 Jun 25.
Reliable assessments of reduced exercise capacity based on resting tests are one of the major challenges in clinical practice. The aim of this study was to evaluate the relationship between hemodynamic parameters obtained via resting tests (echocardiography and impedance cardiography (ICG)) and objective parameters of exercise capacity assessed via cardiopulmonary exercise testing and exercise ICG in patients with controlled arterial hypertension (AH). The left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic function parameters (e', E/A, E/e'), cardiac output (CO), stroke volume (SV), and systemic vascular resistance index were evaluated for any correlations with selected parameters of exercise capacity, such as peak oxygen uptake (VO) and peak CO in 93 people with AH (mean age 54 years, 47 women). Statistically relevant correlations occurred between indices of exercise capacity (peak VO; peak CO) and only the following hemodynamic parameters: diastolic blood pressure (R = 0.23, p = 0.026; R = 0.24, p = 0.021; respectively), e' (R = 0.32, p = 0.002; R = 0.24, p = 0.027), E/e' (R = 0.35, p < 0.001; ns), E/A (R = 0.23, p = 0.030; R = 0.21, p = 0.047), SV at rest (ns; R = 0.24, p = 0.019), and CO at rest (ns; R = 0.21, borderline p = 0.052). No significant correlations between the exercise capacity parameters and either LVEF or GLS were observed. No hemodynamic parameter proved to be an independent correlate of either peak VO or peak CO. The association between hemodynamic parameters at rest and parameters of exercise capacity was weak and limited to selected parameters of diastolic function. Exercise capacity assessment in patients with AH based on resting tests alone is insufficiently reliable and should be supplemented with exercise tests.
基于静息测试的运动能力可靠评估是临床实践中的主要挑战之一。本研究旨在评估通过静息测试（超声心动图和阻抗心动图（ICG））获得的血流动力学参数与通过心肺运动测试和运动 ICG 评估的运动能力的客观参数之间的关系，在患有控制良好的动脉高血压（AH）的患者中。评估左心室射血分数（LVEF）、整体纵向应变（GLS）、舒张功能参数（e'、E/A、E/e'）、心输出量（CO）、每搏输出量（SV）和系统血管阻力指数与运动能力的选定参数（如峰值摄氧量（VO）和峰值 CO）之间的相关性，共纳入 93 名 AH 患者（平均年龄 54 岁，47 名女性）。在静息状态下，仅以下血流动力学参数与运动能力指数（峰值 VO；峰值 CO）呈统计学显著相关：舒张压（R=0.23，p=0.026；R=0.24，p=0.021）、e'（R=0.32，p=0.002；R=0.24，p=0.027）、E/e'（R=0.35，p<0.001；无统计学意义）、E/A（R=0.23，p=0.030；R=0.21，p=0.047）、静息状态下的 SV（无统计学意义；R=0.24，p=0.019）和 CO（无统计学意义；R=0.21，p=0.047）。在运动能力参数与 LVEF 或 GLS 之间未观察到显著相关性。没有血流动力学参数被证明是峰值 VO 或峰值 CO 的独立相关因素。静息状态下的血流动力学参数与运动能力参数之间的关联较弱，且仅限于舒张功能的某些参数。仅基于静息测试评估 AH 患者的运动能力不够可靠，应辅以运动测试。
