Cardiovascular Clinical Academic Group, St George's University of London, London, UK.
Cardiovascular Clinical Academic Group, St George's University of London, London, UK
Heart. 2022 Nov 24;108(24):1938-1944. doi: 10.1136/heartjnl-2021-319824.
There is a paucity of studies looking at the natural history of valvular heart disease (VHD) in exercising individuals, and exercise recommendations are largely based on expert consensus. All individuals with VHD should be encouraged to avoid sedentary behaviour by engaging in at least 150 min of physical activity every week, including strength training. There are generally no exercise restrictions to individuals with mild VHD. Regurgitant lesions are better tolerated compared with stenotic lesions and as such the recommendations are more permissive for moderate-to-severe regurgitant VHD. Individuals with severe aortic regurgitation can still partake in moderate-intensity exercise provided the left ventricle (LV) and aorta are not significantly dilated and the ejection fraction (EF) remains >50%. Similarly, individuals with severe mitral regurgitation can partake in moderate-intensity exercise if the LV end-diastolic diameter <60 mm, the EF ≥60%, resting pulmonary artery pressure <50 mm Hg and there is an absence of arrhythmias on exercise testing. Conversely, individuals with severe aortic or mitral stenosis are advised to partake in low-intensity exercise. For individuals with bicuspid aortic valve, in the absence of aortopathy, the guidance for tricuspid aortic valve dysfunction applies. Mitral valve prolapse has several clinical, ECG and cardiac imaging markers of increased arrhythmic risk; and if any are present, individuals should refrain from high-intensity exercise.
关于运动个体中心瓣膜性心脏病（VHD）的自然病史，研究甚少，运动建议主要基于专家共识。所有 VHD 患者都应被鼓励通过每周至少进行 150 分钟的身体活动（包括力量训练）来避免久坐行为。对于轻度 VHD 患者，通常没有运动限制。反流性病变比狭窄性病变更耐受，因此对于中度至重度反流性 VHD 的建议更为宽松。只要左心室（LV）和主动脉没有明显扩张，射血分数（EF）保持>50%，患有严重主动脉瓣反流的个体仍可以参加中等强度的运动。同样，如果 LV 舒张末期直径<60mm，EF≥60%，静息肺动脉压<50mmHg，且运动试验无心律失常，则患有严重二尖瓣反流的个体可以参加中等强度的运动。相反，患有严重主动脉瓣或二尖瓣狭窄的个体建议参加低强度运动。对于二叶式主动脉瓣患者，如果不存在主动脉病变，则适用三尖瓣主动脉瓣功能障碍的指南。二尖瓣脱垂有几个心律失常风险增加的临床、心电图和心脏成像标志物；如果存在任何标志物，个体应避免高强度运动。
