Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Respir Physiol Neurobiol. 2023 Dec;318:104167. doi: 10.1016/j.resp.2023.104167. Epub 2023 Sep 26.
Heart failure with preserved ejection fraction (HFpEF) patients have an increased ventilatory demand. Whether their ventilatory capacity can meet this increased demand is unknown, especially in those with obesity. Body composition (DXA) and pulmonary function were measured in 20 patients with HFpEF (69 ± 6 yr;9 M/11 W). Cardiorespiratory responses, breathing mechanics, and ratings of perceived breathlessness (RPB, 0-10) were measured at rest, 20 W, and peak exercise. FVC correlated with %body fat (R =0.51,P = 0.0006), V̇O (%predicted,R =0.32,P = 0.001), and RPB (R =0.58,P = 0.0004). %Body fat correlated with end-expiratory lung volume at rest (R =0.76,P < 0.001), 20 W (R =0.72,P < 0.001), and peak exercise (R =0.74,P < 0.001). Patients were then divided into two groups: those with lower ventilatory reserve (FVC<3 L,2 M/10 W) and those with higher ventilatory reserve (FVC>3.8 L,7 M/1 W). V̇O was ∼22% less (p < 0.05) and RPB was twice as high at 20 W (p < 0.01) in patients with lower ventilatory reserve. Ventilatory reserves are limited in patients with HFpEF and obesity; indeed, the margin between ventilatory demand and capacity is so narrow that exercise capacity could be ventilatory limited in many patients.
射血分数保留的心力衰竭(HFpEF)患者的通气需求增加。他们的通气能力是否能够满足这种增加的需求尚不清楚,尤其是在肥胖患者中。在 20 名 HFpEF 患者(69±6 岁;9 名男性/11 名女性)中测量了身体成分(DXA)和肺功能。在休息时、20W 和最大运动时测量了心肺反应、呼吸力学和感知呼吸困难程度(0-10 分)。FVC 与 %体脂(R=0.51,P=0.0006)、V̇O(%预计值,R=0.32,P=0.001)和 RPB(R=0.58,P=0.0004)相关。%体脂与静息时呼气末肺容积(R=0.76,P<0.001)、20W 时(R=0.72,P<0.001)和最大运动时(R=0.74,P<0.001)相关。然后将患者分为两组:通气储备较低(FVC<3L,2 名男性/10 名女性)和通气储备较高(FVC>3.8L,7 名男性/1 名女性)。在通气储备较低的患者中,V̇O 降低了约 22%(p<0.05),而在 20W 时,RPB 升高了一倍(p<0.01)。HFpEF 和肥胖患者的通气储备有限;事实上,通气需求和容量之间的差距如此之小,以至于许多患者的运动能力可能受到通气限制。
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