Nishizaki Mari, Ogawa Aiko, Matsubara Hiromi
Department of Rehabilitation, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan.
Department of Clinical Science, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan.
J Clin Med. 2021 May 9;10(9):2024. doi: 10.3390/jcm10092024.
The right ventricle (RV) is more sensitive to an increase in afterload than the left ventricle (LV), and RV afterload during exercise increases more easily than LV afterload. Pulmonary arterial hypertension (PAH)-specific therapy has improved pulmonary hemodynamics at rest; however, the pulmonary hemodynamic response to exercise is still abnormal in most patients with PAH. In these patients, RV afterload during exercise could be higher, resulting in a greater increase in RV wall stress. Recently, an increasing number of studies have indicated the short-term efficacy of exercise training. However, considering the potential risk of promoting myocardial maladaptive remodeling, even low-intensity repetitive exercise training could lead to long-term clinical deterioration. Further studies investigating the long-term effects on the RV and pulmonary vasculature are warranted. Although the indications for exercise training for patients with PAH have been expanding, exercise training may be associated with various risks. Training programs along with risk stratification based on the pulmonary hemodynamic response to exercise may enhance the safety of patients with PAH.
右心室（RV）比左心室（LV）对后负荷增加更敏感，并且运动期间右心室后负荷比左心室后负荷更容易增加。肺动脉高压（PAH）特异性治疗已改善静息时的肺血流动力学；然而，大多数PAH患者运动时的肺血流动力学反应仍异常。在这些患者中，运动期间右心室后负荷可能更高，导致右心室壁应力更大增加。最近，越来越多的研究表明运动训练的短期疗效。然而，考虑到促进心肌适应不良重塑的潜在风险，即使是低强度重复运动训练也可能导致长期临床恶化。有必要进一步研究其对右心室和肺血管系统的长期影响。尽管PAH患者运动训练的适应症一直在扩大，但运动训练可能与各种风险相关。基于运动时肺血流动力学反应的训练计划以及风险分层可能会提高PAH患者的安全性。
