Vitez Luka, Bunc Matjaž, Jug Borut
Department of Cardiology, Division of Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
J Cardiovasc Dev Dis. 2023 Aug 12;10(8):343. doi: 10.3390/jcdd10080343.
Transcatheter aortic valve implantation (TAVI) improves event-free survival in patients with severe aortic stenosis, but patients' exercise capacity remains poor after the procedure. Therefore, we sought to compare the effects of a supervised center-based exercise training program and unsupervised exercise routine on exercise capacity and vascular function in patients after TAVI. Patients were randomized to either center-based exercise training (12-24 sessions of combined aerobic and low-weight resistance training twice weekly for 8-12 weeks) or an unsupervised home-based exercise routine (initial appraisal with detailed recommendations and monthly follow-up). Exercise capacity (cardiopulmonary testing) and vascular function (ultrasonographic measurement of flow-mediated vasodilation (FMD) and arterial stiffness) were assessed at the baseline and after the study period. We included 23 patients (mean age of 81 years, 61% women), with higher-than-expected drop-out rates (41%) because of the coronavirus-19 pandemic outbreak. Exercise capacity improved over time, irrespective of the intervention group: 0.09 mL/min/kg increase in peak oxygen uptake (95% CI [0.01-0.16]; = 0.02), 8.2 Watts increase in workload (95% CI [0.6-15.8]; = 0.034), and 47 s increase in cumulative exercise time (95% CI [5.0-89.6]; = 0.029). A between-group difference in change over time (treatment effect) was detected only for FMD (4.49%; 95% CI [2.35; 6.63], < 0.001), but not for other outcome variables. Both supervised and unsupervised exercise training improve exercise capacity and vascular function in patients after TAVI, with supervised exercise training possibly yielding larger improvements in vascular function, as determined by FMD.
经导管主动脉瓣植入术（TAVI）可改善重度主动脉瓣狭窄患者的无事件生存期，但术后患者的运动能力仍较差。因此，我们试图比较有监督的基于中心的运动训练计划和无监督的运动常规对TAVI术后患者运动能力和血管功能的影响。患者被随机分为基于中心的运动训练组（每周两次，进行12 - 24节有氧和低重量抗阻训练组合，持续8 - 12周）或无监督的家庭运动常规组（进行初始评估并给出详细建议，每月随访）。在基线和研究期结束后评估运动能力（心肺测试）和血管功能（通过超声测量血流介导的血管舒张（FMD）和动脉僵硬度）。我们纳入了23例患者（平均年龄81岁，61%为女性），由于新冠疫情爆发，退出率高于预期（41%）。无论干预组如何，运动能力均随时间改善：峰值摄氧量增加0.09 mL/min/kg（95%可信区间[0.01 - 0.16]；P = 0.02），工作量增加8.2瓦（95%可信区间[0.6 - 15.8]；P = 0.034），累积运动时间增加47秒（95%可信区间[5.0 - 89.6]；P = 0.029）。仅在FMD方面检测到组间随时间变化的差异（治疗效果）（4.49%；95%可信区间[2.35；6.63]，P < 0.001），而其他结局变量未检测到。有监督和无监督的运动训练均可改善TAVI术后患者的运动能力和血管功能，通过FMD测定，有监督的运动训练可能在血管功能方面带来更大改善。
