高强度和中等强度间歇训练在射血分数保留心力衰竭中的应用：一项随机对照试验的荟萃分析。
High-intensity and moderate-intensity interval training in heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials.
机构信息
Department of Cardiology, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, First Affiliated Hospital of Gannan Medical University, Gannan Medical University, University Town, Ganzhou Development District, Ganzhou, China.
Institute of Experimental Cardiovascular Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Medicine (Baltimore). 2023 Feb 22;102(8):e33010. doi: 10.1097/MD.0000000000033010.
BACKGROUND
Exercise training significantly improves cardiorespiratory fitness (CRF) in heart failure with reduced ejection fraction (HFrEF) patients, but high-intensity interval training (HIIT) is not superior to moderate-intensity interval training (MIIT). Whether HIIT is more beneficial than MIIT in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear.
METHODS
On August 29, 2021, we conducted a comprehensive computerized literature search of the Medline, EMBASE, Web of Science, and Cochrane databases using the following keywords: "HF or diastolic HF or HFpEF or HF with normal ejection fraction and exercise training or aerobic exercise or isometric exercises or physical activity or cardiac rehabilitation." Only randomized controlled trials (RCTs) reporting comparisons between HIIT and MIIT in HFpEF were included in the final analysis to maintain consistency and obtain robust pooled estimates. Methodological quality was assessed based on the ratings of individual biases. To generate an overall test statistic, the data were analyzed using the random-effects model for a generic inverse variance. Outcome measures were reported as an odds ratio, and confidence intervals (CIs) were set at 95%. The study followed PRISMA guidelines.
RESULTS
This meta-analysis included only RCTs comparing the efficacy of HIIT and MIIT in HFpEF patients. This study included 150 patients from 3 RCTs. In the current pooled data analysis, HIIT significantly improves diastolic function measured by E/A ratio (WMD, 0.13; 95% CI, 0.03-0.23, P = .009). However, no significant change was observed in the diastolic function measured by E/e' ratio (WMD, 0.39; 95% CI, -2.40 to 3.18, P = .78), and CRF evaluated by both VO2 (mL/kg per min; WMD, -0.86; 95%CI, -5.27 to 3.55, P = .70) and VE/CO2 slope (WMD, 0.15; 95% CI, -10.24 to 10.53, P = .98), and systolic function (EF-WMD, -2.39; 95% CI, -12.16% to 7.38%, P = .63) between HIIT and MIIT in patients with HFpEF.
CONCLUSION
In HFpEF patients, HIIT may be superior to MIIT in improving diastolic function, measured by E/A, but not CRF and left ventricular systolic function.
背景
运动训练可显著改善射血分数降低的心力衰竭（HFrEF）患者的心肺适能（CRF），但高强度间歇训练（HIIT）并不优于中等强度间歇训练（MIIT）。在射血分数保留的心力衰竭（HFpEF）患者中，HIIT 是否比 MIIT 更有益尚不清楚。
方法
2021 年 8 月 29 日，我们使用以下关键词在 Medline、EMBASE、Web of Science 和 Cochrane 数据库中进行了全面的计算机文献检索：“HF 或舒张性 HF 或 HFpEF 或 HF 与正常射血分数和运动训练或有氧运动或等长运动或体力活动或心脏康复”。仅纳入 HFpEF 中 HIIT 与 MIIT 比较的随机对照试验（RCT）进行最终分析，以保持一致性并获得稳健的汇总估计值。根据个体偏倚的评分评估方法学质量。为了生成整体检验统计量，使用随机效应模型对通用逆方差进行数据分析。结果以优势比表示，置信区间（CI）设为 95%。该研究遵循 PRISMA 指南。
结果
这项荟萃分析仅包括比较 HIIT 和 MIIT 在 HFpEF 患者中的疗效的 RCT。这项研究纳入了来自 3 项 RCT 的 150 名患者。在当前的汇总数据分析中，HIIT 可显著改善通过 E/A 比值测量的舒张功能（WMD，0.13；95%CI，0.03-0.23，P =.009）。然而，E/e'比值测量的舒张功能无明显变化（WMD，0.39；95%CI，-2.40 至 3.18，P =.78），通过 VO2（mL/kg 每分；WMD，-0.86；95%CI，-5.27 至 3.55，P =.70）和 VE/CO2 斜率（WMD，0.15；95%CI，-10.24 至 10.53，P =.98）评估的 CRF，以及 HFpEF 患者的收缩功能（EF-WMD，-2.39；95%CI，-12.16%至 7.38%，P =.63），HIIT 与 MIIT 之间无显著差异。
结论
在 HFpEF 患者中，HIIT 可能优于 MIIT，改善通过 E/A 测量的舒张功能，但对 CRF 和左心室收缩功能没有影响。
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