Watanabe Tsubasa, Murase Norio, Kime Ryotaro, Kurosawa Yuko, Fuse Sayuri, Hamaoka Takafumi
Department of Sports Medicine for Health Promotion, Tokyo Medical University, Tokyo, Japan.
Adv Exp Med Biol. 2021;1269:101-105. doi: 10.1007/978-3-030-48238-1_16.
The primary symptom in patients with chronic heart failure (CHF) is exercise intolerance. Previous studies have reported that reduced exercise tolerance in CHF can be explained not only by cardiac output (a central factor) but also by reduced skeletal muscle aerobic capacity (a peripheral factor). Although exercise training in CHF improves exercise tolerance, few studies have evaluated the effects of exercise training on each specific central and peripheral factor in CHF. The aim of this study was to investigate the central and peripheral aerobic functions in CHF and the effects of exercise training in CHF on cardiac output and skeletal muscle deoxygenation during exercise. We assessed peak oxygen uptake (VO) during cardiopulmonary exercise testing, peak cardiac output (CO) using noninvasive hemodynamic monitoring, and muscle oxygen saturation (SmO) using near-infrared spectroscopy (NIRS). Patients with CHF were trained for 12 weeks and performed ramp cycling exercise until exhaustion before and after the exercise training. Peak VO, peak CO, and SmO changes from rest to peak exercise (ΔSmO) were significantly lower in CHF than those in healthy subjects. As a result of exercise training, peak oxygen uptake in patients with CHF was improved and positively associated with change in ΔSmO. In contrast, there was no change in peak cardiac output. The results of this study indicate that both cardiac and skeletal muscle functions in patients with CHF were lower than those in healthy subjects. Further, the results suggest that the improvement of exercise capacity in patients with CHF by exercise training was related to the improved utilization of oxygen (a peripheral factor) in skeletal muscle.
慢性心力衰竭（CHF）患者的主要症状是运动耐量下降。既往研究报道，CHF患者运动耐量降低不仅可由心输出量（一个中心因素）来解释，还可由骨骼肌有氧能力降低（一个外周因素）来解释。尽管CHF患者进行运动训练可改善运动耐量，但很少有研究评估运动训练对CHF中每个特定的中心和外周因素的影响。本研究的目的是调查CHF患者的中心和外周有氧功能，以及CHF患者运动训练对运动期间心输出量和骨骼肌脱氧的影响。我们在心肺运动试验中评估了峰值摄氧量（VO），使用无创血流动力学监测评估了峰值心输出量（CO），并使用近红外光谱（NIRS）评估了肌肉氧饱和度（SmO）。CHF患者接受了12周的训练，并在运动训练前后进行递增式自行车运动直至力竭。CHF患者从静息到运动峰值时的峰值VO、峰值CO和SmO变化（ΔSmO）显著低于健康受试者。运动训练的结果显示，CHF患者的峰值摄氧量得到改善，且与ΔSmO的变化呈正相关。相比之下，峰值心输出量没有变化。本研究结果表明，CHF患者的心脏和骨骼肌功能均低于健康受试者。此外，结果表明，运动训练改善CHF患者运动能力与骨骼肌中氧利用（一个外周因素）的改善有关。
