监督训练疗法对重度肺动脉高压及无法手术或持续性慢性血栓栓塞性肺动脉高压患者肺动脉顺应性和每搏输出量的影响

Effect of Supervised Training Therapy on Pulmonary Arterial Compliance and Stroke Volume in Severe Pulmonary Arterial Hypertension and Inoperable or Persistent Chronic Thromboembolic Pulmonary Hypertension.

作者信息

Nagel Christian, Benjamin Nicola, Egenlauf Benjamin, Eichstaedt Christina A, Fischer Christine, Palevičiūtė Eglė, Čelutkienė Jelena, Harutyunova Satenik, Mayer Eckhard, Nasereddin Mohammed, Marra Alberto M, Grünig Ekkehard, Guth Stefan

机构信息

Center for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Heidelberg, Germany.

Department of Respiratory Care Medicine and Thoracic Surgery, Klinikum Mittelbaden, Baden-Baden Balg, Baden-Baden, Germany.

出版信息

Respiration. 2021;100(5):369-378. doi: 10.1159/000512316. Epub 2021 Mar 25.

DOI:10.1159/000512316

PMID:33765679

Abstract

BACKGROUND

Pulmonary arterial compliance (PAC) is a prognostic parameter in pulmonary arterial hypertension (PAH) reflecting the elasticity of the pulmonary vessels.

OBJECTIVES

The objective of this post hoc analysis of a prospective randomized controlled trial (RCT) was to assess the effect of exercise training on PAC and stroke volume (SV) in patients with PAH and persistent/inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

METHOD

From the previous RCT, 43 out of 87 patients with severe PAH (n = 29) and CTEPH (n = 14) had complete haemodynamic examinations at baseline and after 15 weeks by right heart catheterization and were analysed (53% female, 79% World Health Organization functional class III/IV, 58% combination therapy, 42% on supplemental oxygen therapy, training group n = 24, and control group n = 19). Medication remained unchanged for all patients.

RESULTS

Low-dose exercise training at 4-7 days/week significantly improved PAC (training group 0.33 ± 0.65 mL/mm Hg vs. control group -0.06 ± 1.10 mL/mm Hg; mean difference 0.39 mL/mm Hg, 95% confidence interval [CI] 0.15-0.94 mL/mm Hg; p = 0.004) and SV (training group 9.9 ± 13.4 mL/min vs. control group -4.2 ± 11.0 mL/min; mean difference 14.2 mL, 95% CI 6.5-21.8 mL; p < 0.001) in the training versus control group. Furthermore, exercise training significantly improved cardiac output and pulmonary vascular resistance at rest, peak oxygen consumption, and oxygen pulse.

CONCLUSIONS

Our findings suggest that supervised exercise training may improve right ventricular function and PAC at the same time. Further prospective studies are needed to evaluate these findings.

摘要

背景

肺动脉顺应性（PAC）是肺动脉高压（PAH）的一个预后参数，反映肺血管的弹性。

目的

这项对一项前瞻性随机对照试验（RCT）的事后分析的目的是评估运动训练对PAH和持续性/不可手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者的PAC和每搏输出量（SV）的影响。

方法

在前一项RCT中，87例重度PAH患者（n = 29）和CTEPH患者（n = 14）中有43例在基线时和15周后通过右心导管检查进行了完整的血流动力学检查并接受分析（女性占53%，世界卫生组织功能分级III/IV级占79%，联合治疗占58%，接受补充氧气治疗占42%，训练组n = 24，对照组n = 19）。所有患者的药物治疗均保持不变。

结果

每周4 - 7天的低剂量运动训练显著改善了PAC（训练组0.33±0.65 mL/mm Hg vs.对照组 - 0.06±1.10 mL/mm Hg；平均差异0.39 mL/mm Hg，95%置信区间[CI] 0.15 - 0.94 mL/mm Hg；p = 0.004）和SV（训练组9.9±13.4 mL/min vs.对照组 - 4.2±11.0 mL/min；平均差异14.2 mL，95% CI 6.5 - 21.8 mL；p < 0.001），训练组与对照组相比。此外，运动训练显著改善了静息时的心输出量和肺血管阻力、峰值耗氧量和氧脉搏。