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HFpEF 合并肥胖患者的通气局限性。

Ventilatory limitations in patients with HFpEF and obesity.

机构信息

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.

出版信息

Respir Physiol Neurobiol. 2023 Dec;318:104167. doi: 10.1016/j.resp.2023.104167. Epub 2023 Sep 26.


DOI:10.1016/j.resp.2023.104167
PMID:37758032
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11079902/
Abstract

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.

摘要

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。

相似文献

[1]
Ventilatory limitations in patients with HFpEF and obesity.

Respir Physiol Neurobiol. 2023-12

[2]
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Ann Am Thorac Soc. 2023-10

[3]
Higher Work of Breathing During Exercise in Heart Failure With Preserved Ejection Fraction.

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[4]
Reducing Pulmonary Capillary Wedge Pressure During Exercise Exacerbates Exertional Dyspnea in Patients With Heart Failure With Preserved Ejection Fraction: Implications for V˙/Q˙ Mismatch.

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[5]
Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction.

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[6]
Sex differences in the ventilatory responses to exercise in mild to moderate obesity.

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[7]
Simultaneous Measurement of Lung Diffusing Capacity and Pulmonary Hemodynamics Reveals Exertional Alveolar-Capillary Dysfunction in Heart Failure With Preserved Ejection Fraction.

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[8]
Regional Adipose Distribution and its Relationship to Exercise Intolerance in Older Obese Patients Who Have Heart Failure With Preserved Ejection Fraction.

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[9]
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[10]
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引用本文的文献

[1]
Physiologic Phenotyping of Responses to Exercise and Activity in Heart Failure.

Circ Res. 2025-7-7

[2]
Heart-Lung Interactions in HFpEF: Dynamic Hyperinflation and Exercise PCWP.

JACC Heart Fail. 2025-8

[3]
Pulmonary gas exchange in relation to exercise pulmonary hypertension in patients with heart failure with preserved ejection fraction.

Eur Respir J. 2025-2-13

[4]
Identifying the Mechanisms of a Peripherally Limited Exercise Phenotype in Patients With Heart Failure With Preserved Ejection Fraction.

Circ Heart Fail. 2024-8

[5]
Respiratory symptom perception during exercise in patients with heart failure with preserved ejection fraction.

Respir Physiol Neurobiol. 2024-7

本文引用的文献

[1]
Challenging the Hemodynamic Hypothesis in Heart Failure With Preserved Ejection Fraction: Is Exercise Capacity Limited by Elevated Pulmonary Capillary Wedge Pressure?

Circulation. 2023-1-31

[2]
Higher Work of Breathing During Exercise in Heart Failure With Preserved Ejection Fraction.

Chest. 2023-6

[3]
Sex differences in the ventilatory responses to exercise in mild to moderate obesity.

Exp Physiol. 2022-8

[4]
Alveolar Dead Space Is Augmented During Exercise in Patients With Heart Failure With Preserved Ejection Fraction.

Chest. 2022-12

[5]
Physiological dead space during exercise in patients with heart failure with preserved ejection fraction.

J Appl Physiol (1985). 2022-3-1

[6]
Using Cardiopulmonary Exercise Testing to Understand Dyspnea and Exercise Intolerance in Respiratory Disease.

Chest. 2022-6

[7]
ERS/ATS technical standard on interpretive strategies for routine lung function tests.

Eur Respir J. 2022-7

[8]
Editorial: Clinical Cardiopulmonary Exercise Testing.

Front Physiol. 2021-6-28

[9]
Sex Differences in Heart Failure With Preserved Ejection Fraction.

J Am Heart Assoc. 2021-2

[10]
Impact of severe obesity on exercise performance in heart failure with preserved ejection fraction.

Physiol Rep. 2020-11

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