Zhou Na, Forton Kevin, Motoji Yoshiki, Scoubeau Corentin, Klass Malgorzata, Naeije Robert, Faoro Vitalie
Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Science, Université Libre de Bruxelles, Brussels, Belgium.
Department of Cardiology, Erasmus University Hospital, Brussels, Belgium.
Front Cardiovasc Med. 2022 Aug 19;9:946155. doi: 10.3389/fcvm.2022.946155. eCollection 2022.
Obesity-related exercise intolerance may be associated with pulmonary vascular and right ventricular dysfunction. This study tested the hypothesis that decreased pulmonary vascular reserve and right ventricular (RV)-pulmonary arterial (PA) uncoupling contributes to exercise limitation in subjects with obesity.
Seventeen subjects with obesity were matched to normo-weighted healthy controls. All subjects underwent; exercise echocardiography, lung diffusing capacity (DL) for nitric oxide (NO) and carbon monoxide (CO) and an incremental cardiopulmonary exercise test. Cardiac output (Q), PA pressure (PAP) and tricuspid annular plane systolic excursion (TAPSE) were recorded at increasing exercise intensities. Pulmonary vascular reserve was assessed by multipoint mean PAP (mPAP)/Q relationships with more reserve defined by lesser increase in mPAP at increased Q, and RV-PA coupling was assessed by the TAPSE/systolic PAP (sPAP) ratio.
At rest, subjects with obesity displayed lower TAPSE/sPAP ratios (1.00 ± 0.26 vs. 1.19 ± 0.22 ml/mmHg, < 0.05), DL and pulmonary capillary blood volume (52 ± 11 vs. 64 ± 13 ml, < 0.01) compared to controls. Exercise was associated with steeper mPAP-Q slopes, decreased TAPSE/sPAP and lower peak O uptake (VOpeak). The changes in TAPSE/sPAP at exercise were correlated to the body fat mass ( = 0.39, = 0.01) and VOpeak ( = 0.44, < 0.01).
Obesity is associated with a decreased pulmonary vascular and RV-PA coupling reserve which may impair exercise capacity.
肥胖相关的运动不耐受可能与肺血管和右心室功能障碍有关。本研究检验了以下假设：肺血管储备降低和右心室-肺动脉解偶联导致肥胖受试者运动受限。
17名肥胖受试者与体重正常的健康对照者进行匹配。所有受试者均接受运动超声心动图检查、一氧化氮（NO）和一氧化碳（CO）的肺弥散容量（DL）以及递增式心肺运动试验。在运动强度增加时记录心输出量（Q）、肺动脉压（PAP）和三尖瓣环平面收缩期位移（TAPSE）。通过多点平均肺动脉压（mPAP）/Q关系评估肺血管储备，Q增加时mPAP增加较少则表示储备更多，通过TAPSE/收缩期肺动脉压（sPAP）比值评估右心室-肺动脉耦合。
与对照组相比，肥胖受试者在静息状态下TAPSE/sPAP比值更低（1.00±0.26 vs. 1.19±0.22 ml/mmHg，P<0.05）、DL和肺毛细血管血容量更低（52±11 vs. 64±13 ml，P<0.01）。运动与更陡的mPAP-Q斜率、降低的TAPSE/sPAP和更低的峰值摄氧量（VO₂peak）相关。运动时TAPSE/sPAP的变化与体脂量（r=0.39，P=0.01）和VO₂peak（r=0.44，P<0.01）相关。
肥胖与肺血管和右心室-肺动脉耦合储备降低有关，这可能损害运动能力。
