College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada.
College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada.
Rev Cardiovasc Med. 2022 Feb 21;23(2):72. doi: 10.31083/j.rcm2302072.
Heart failure with reduced ejection fraction is associated with increased exercise intolerance, morbidity, and mortality. Importantly, exercise intolerance in heart failure with reduced ejection fraction is a key factor limiting patient quality of life and survival. Exercise intolerance in heart failure with reduced ejection fraction stems from a multi-organ failure to maintain homeostasis at rest and during exercise, including the heart, skeletal muscle, and autonomic nervous system, lending itself to a system constantly trying to "catch-up". Hemodynamic control during exercise is regulated primarily by the autonomic nervous system, whose operation, in turn, is partly regulated via reflexive information from exercise-stimulated receptors throughout the body (e.g., arterial baroreflex, central and peripheral chemoreceptors, and the muscle metabo- and mechanoreflexes). Persons with heart failure with reduced ejection fraction exhibit malfunctioning autonomic reflexes, which lead to exaggerated sympathoexcitation and attenuated parasympathetic tone. Chronic elevation of sympathetic activity is associated with increased morbidity and mortality. In this review, we provide an overview of how each main exercise-related autonomic reflex is changed in heart failure with reduced ejection fraction, and the role of exercise training in attenuating or reversing the counterproductive changes.
射血分数降低的心力衰竭与运动不耐受、发病率和死亡率增加有关。重要的是，射血分数降低的心力衰竭患者的运动不耐受是限制患者生活质量和生存的关键因素。射血分数降低的心力衰竭患者的运动不耐受源于多器官衰竭，无法在休息和运动期间维持内稳态，包括心脏、骨骼肌和自主神经系统，导致系统不断试图“追赶”。运动期间的血液动力学控制主要由自主神经系统调节，自主神经系统的运作反过来又部分受到来自全身运动刺激感受器的反射信息的调节（例如，动脉压力反射、中枢和外周化学感受器以及肌肉代谢和机械感受器反射）。射血分数降低的心力衰竭患者表现出自主反射功能障碍，导致交感神经兴奋过度和副交感神经张力减弱。慢性升高的交感神经活动与发病率和死亡率增加有关。在这篇综述中，我们概述了射血分数降低的心力衰竭中与运动相关的每个主要自主反射如何发生变化，以及运动训练在减弱或逆转这些适得其反的变化中的作用。
