Scrutinio Domenico, Guida Pietro, La Rovere Maria Teresa, Bussotti Maurizio, Corrà Ugo, Forni Giovanni, Raimondo Rosa, Scalvini Simonetta, Passantino Andrea
Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Via Generale Nicola Bellomo 73/75, Bari, Italy.
Eur J Intern Med. 2023 Apr;110:86-92. doi: 10.1016/j.ejim.2023.02.002. Epub 2023 Feb 8.
There is limited evidence regarding the effects of cardiac rehabilitation (CR) in patients with heart failure and preserved ejection fraction (HFpEF).
We studied 1784 patients admitted to inpatient CR. The patients were grouped into HFpEF (EF≥0.50), HF with mildly reduced EF (HFmrEF; EF 41-49), and HF with reduced EF (HFrEF; EF≤0.40). A standardized 6-min walking test was performed at admission and discharge. Measures of functional outcome were: (1) absolute increase in 6-min walking distance (6MWD) from admission to discharge >50 m and (2) increase in 6MWD to ≥300 among the patients who walked <300 m at admission.
After adjustment, the patients with HFpEF or HFmrEF were as likely as those with HFrEF to achieve an increase in 6MWD >50 m (odds ratio 0.95 [95%CI 0.71-1.24; p=0.648] and 1.04 [95%CI 0.77-1.41; p=0.769], respectively) or an increase in 6MWD to ≥300 m (odds ratio 0.79 [95%CI 0.51-1.23; p=0.299] and 0.65 [95%CI 0.38-1.12; p=0.118], respectively). The adjusted hazard ratio of 5-year mortality for patients who achieved an increase in 6MWD >50 m was 0.60 (95%CI 0.51-0.71; p<0.001) and that for patients who achieved an increase in 6MWD at discharge to ≥300 m 0.61 (95%CI 0.48-0.79; p<0.001). In each EF group, both outcomes remained independently associated with improved survival.
Our data suggest that patients with HFpEF or HFmrEF are as likely as those with HFrEF to benefit from CR in terms of functional improvement. Functional improvement was independently associated with improved long-term survival, regardless of EF.
关于心脏康复（CR）对射血分数保留的心力衰竭（HFpEF）患者的影响，证据有限。
我们研究了1784例入住CR病房的患者。患者被分为HFpEF组（射血分数[EF]≥0.50）、轻度射血分数降低的心力衰竭（HFmrEF；EF 41%-49%）组和射血分数降低的心力衰竭（HFrEF；EF≤0.40）组。入院时和出院时进行标准化6分钟步行试验。功能结局指标为：（1）入院至出院6分钟步行距离（6MWD）的绝对增加>50米；（2）入院时步行距离<300米的患者6MWD增加至≥300米。
调整后，HFpEF或HFmrEF患者与HFrEF患者实现6MWD增加>50米（优势比分别为0.95[95%置信区间0.71-1.24；p=0.648]和1.04[95%置信区间0.77-1.41；p=0.769]）或6MWD增加至≥300米（优势比分别为0.79[95%置信区间0.51-1.23；p=0.299]和0.65[95%置信区间0.38-1.12；p=0.118]）的可能性相同。6MWD增加>50米的患者5年死亡率的调整后风险比为0.60（95%置信区间0.51-0.71；p<0.001），出院时6MWD增加至≥300米的患者为0.61（95%置信区间0.48-0.79；p<0.001）。在每个EF组中，这两个结局均与生存率改善独立相关。
我们的数据表明，在功能改善方面，HFpEF或HFmrEF患者与HFrEF患者从CR中获益的可能性相同。功能改善与长期生存率改善独立相关，与EF无关。
