心力衰竭伴射血分数保留患者运动时呼吸功增加。
Higher Work of Breathing During Exercise in Heart Failure With Preserved Ejection Fraction.
机构信息
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; School of Kinesiology, Applied Health and Recreation, Oklahoma State University, Stillwater, OK.
出版信息
Chest. 2023 Jun;163(6):1492-1505. doi: 10.1016/j.chest.2022.11.039. Epub 2022 Dec 5.
BACKGROUND
It is unknown if pulmonary alterations in heart failure with preserved ejection fraction (HFpEF) impact respiratory mechanics during exercise.
RESEARCH QUESTION
Are the operating lung volumes, work of breathing (Wb), and power of breathing (Pb) abnormal in patients with HFpEF during exercise?
STUDY DESIGN AND METHODS
Patients with HFpEF (n = 8; median age, 71 years [interquartile range (IQR), 66-80 years]) and control participants (n = 9; median age, 68 years [IQR, 64-74 years]) performed incremental cycling to volitional exhaustion. Esophageal pressure, end-expiratory lung volume (EELV), inspiratory lung volume (EILV), and ventilatory variables were compared at similar absolute (30 and 50 L/min) and relative (45% of peak, 70% of peak, and 100% of peak) minute ventilation (V.) during exercise.
RESULTS
During exercise, EELVs were not different between patients with HFpEF and control participants (P > .13 for all). EILVs were lower in patients with HFpEF than control participants at 45% and 70% V. peak (P < .03 for all). Dynamic lung compliance was lower in patients with HFpEF than control participants at 30 L/min, 50 L/min, 45% V. peak, and 100% V. peak (P < .04 for all). Compared with control participants, patients with HFpEF showed higher total Wb and Pb at 30 L/min (Wb: median, 1.08 J/L [IQR, 0.93-1.82 J/L] vs 0.52 J/L [IQR, 0.43-0.71 J/L]; Pb: median, 36 J/min [IQR, 30-59 J/min] vs 17 J/min [IQR, 11-23 J/min] and 50 L/min; Wb: median, 1.40 J/L [IQR, 1.27-1.68 J/L] vs 0.90 J/L [IQR, 0.74-1.05 J/L]; Pb: median, 73 J/min [IQR, 60-83 J/min] vs 45 J/min [IQR, 33-63 J/min]; P < .01 for all). At 30 and 50 L/min, inspiratory and expiratory resistive Wb and Pb were higher in patients with HFpEF than control participants (P < .04 for all). Total Wb was higher for patients with HFpEF than control participants at 45% of V. peak (P = .02). Total Pb was higher for control participants than patients with HFpEF at 100% V. peak because of higher inspiratory resistive Pb (P < .04 for both).
INTERPRETATION
These data demonstrate the HFpEF syndrome is associated with pulmonary alterations eliciting a greater Pb during exercise resulting from greater inspiratory and expiratory resistive Pb.
背景
心力衰竭伴射血分数保留（HFpEF）患者的肺部改变是否会影响运动期间的呼吸力学尚不清楚。
研究问题
HFpEF 患者在运动过程中是否存在肺功能残气量、呼吸功（Wb）和呼吸功率（Pb）异常？
研究设计和方法
8 例 HFpEF 患者（中位年龄 71 岁[四分位距（IQR），66-80 岁]）和 9 例对照参与者（中位年龄 68 岁[IQR，64-74 岁]）进行递增式踏车至力竭。在相似的绝对（30 和 50 L/min）和相对（45%、70%和 100%峰值）分钟通气量（V.）下，比较食管压力、呼气末肺容量（EELV）、吸气末肺容量（EILV）和通气变量。
结果
在运动过程中，HFpEF 患者和对照组患者的 EELV 无差异（所有 P >.13）。与对照组相比，HFpEF 患者在 45%和 70%V.峰值时的 EILV 更低（所有 P <.03）。与对照组相比，HFpEF 患者在 30 L/min、50 L/min、45%V.峰值和 100%V.峰值时的动态肺顺应性更低（所有 P <.04）。与对照组相比，HFpEF 患者在 30 L/min 时总 Wb 和 Pb 更高（Wb：中位数 1.08 J/L[IQR，0.93-1.82 J/L]比 0.52 J/L[IQR，0.43-0.71 J/L]；Pb：中位数 36 J/min[IQR，30-59 J/min]比 17 J/min[IQR，11-23 J/min]和 50 L/min；Wb：中位数 1.40 J/L[IQR，1.27-1.68 J/L]比 0.90 J/L[IQR，0.74-1.05 J/L]；Pb：中位数 73 J/min[IQR，60-83 J/min]比 45 J/min[IQR，33-63 J/min]；所有 P <.01）。在 30 和 50 L/min 时，HFpEF 患者的吸气和呼气阻力 Wb 和 Pb 高于对照组（所有 P <.04）。HFpEF 患者的总 Wb 在 45%V.峰值时高于对照组（P =.02）。在 100%V.峰值时，对照组患者的总 Pb 高于 HFpEF 患者，这是由于吸气阻力 Pb 较高（两者均 P <.04）。
结论
这些数据表明，HFpEF 综合征与运动期间呼吸功增加有关，这是由于吸气和呼气阻力增加所致。
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