Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Nephrology, Clinic of Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
ESC Heart Fail. 2022 Aug;9(4):2215-2224. doi: 10.1002/ehf2.13985. Epub 2022 May 26.
To investigate the associations of cardiorespiratory fitness with cardiac, vascular, renal and cardiorenal characteristics in chronic heart failure in a telerehabilitation randomized clinical trial. Secondly, to evaluate the associations of cardiorenal syndrome with the effects of exercise.
Sixty-nine heart failure patients attended baseline examination, and 61 patients were randomly assigned 1:1 to 3-month telerehabilitation or control. Data were collected at baseline and 3-month post-intervention, including echocardiography and vascular ultrasound, laboratory tests, exercise test with peak oxygen consumption (VO ) measurement and 6-min walk test (6MWT). Baseline VO and 6MWT distance was 0.85 mL*min kg lower and 20 m shorter per 10 mL/min/1.73m lower estimated glomerular filtration rate (both P < 0.001). Heart failure patients with cardiorenal syndrome had 3.5 (1.1) mL*min *kg lower VO and diastolic dysfunction grade 2-3, and elevated filling pressure was >50% more common compared with those without (all P < 0.05). At the 3-month post-intervention follow-up, only the non-CRS patients in the intervention group increased VO (0.73 (0.51) mLmin kg ), whereas VO in the CRS subpopulation of controls decreased (-1.34 (0.43) mLmin kg ). Cardiorenal syndrome was associated with a decrease in VO in CRS patients compared with non-CRS patients, -0.91 (0.31) vs. 0.39 (0.35) mLmin *kg respectively, P = 0.013.
Cardiorenal syndrome was negatively associated with VO and 6MWT distance in chronic HF, and the associations were stronger than for heart failure phenotypes and other characteristics. The effect of exercise was negatively associated with cardiorenal syndrome. Exercise seems to be as important in heart failure patients with cardiorenal syndrome, and future studies should include CRS patients to reveal the most beneficial type of exercise.
在远程康复随机临床试验中，研究心肺功能与慢性心力衰竭中心血管、肾脏和心肾特征的相关性。其次，评估心肾综合征与运动效果的相关性。
69 例心力衰竭患者接受了基线检查，61 例患者被随机分配到 3 个月的远程康复组或对照组。数据收集在基线和干预后 3 个月进行，包括超声心动图和血管超声、实验室检查、峰值摄氧量（VO ）测量和 6 分钟步行试验（6MWT）的运动试验。基线 VO 和 6MWT 距离每降低 10ml/min/1.73m，估计肾小球滤过率（eGFR）降低 10ml/min，VO 降低 0.85mlminkg，6MWT 距离缩短 20m（均 P < 0.001）。心肾综合征患者的 VO 降低 3.5（1.1）mlmin*kg，舒张功能分级 2-3 级，充盈压升高>50%的情况更为常见（均 P < 0.05）。在干预后的 3 个月随访中，只有干预组中非 CRS 患者的 VO 增加（0.73（0.51）mlminkg），而对照组中 CRS 亚组的 VO 则下降（-1.34（0.43）mlminkg）。与非 CRS 患者相比，CRS 患者的 VO 降低与 CRS 相关，分别为-0.91（0.31）和 0.39（0.35）mlmin*kg，P = 0.013。
心肾综合征与慢性 HF 患者的 VO 和 6MWT 距离呈负相关，且与心力衰竭表型和其他特征的相关性更强。运动的效果与心肾综合征呈负相关。运动对心肾综合征患者同样重要，未来的研究应该包括 CRS 患者，以揭示最有益的运动类型。
