Serafin Adam, Jasic-Szpak Ewelina, Marwick Thomas H, Przewlocka-Kosmala Monika, Ponikowski Piotr, Kosmala Wojciech
Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne VIC 3004, Victoria, Australia.
Int J Cardiol. 2024 Jan 15;395:131553. doi: 10.1016/j.ijcard.2023.131553. Epub 2023 Oct 21.
Skeletal muscle (SM)-associated mechanisms of exercise intolerance in HFpEF are insufficiently defined, and inadequate augmentation of SM blood flow during physical effort may be one of the contributors. Therefore, we sought to investigate the association of SM perfusion response to exertion with exercise capacity in this clinical condition.
Echocardiography and SM microvascular perfusion by contrast-enhanced ultrasound were performed at rest and immediately post-exercise test in 77 HFpEF patients in NYHA class II and III, and in 25 subjects with normal exercise tolerance (stage B). Exercise reserve of cardiac function and SM perfusion was calculated by subtracting resting value from exercise value.
In addition to decreased cardiac functional reserve, HFpEF patients demonstrated significantly reduced SM perfusion reserve as compared to HF stage B, with the degree of impairment being greater in the subgroup with more profound left ventricular (LV) diastolic abnormalities (E/e' > 15 and TRV > 2.8 m/s). SM perfusion reserve was significantly associated with exercise capacity (beta = 0.33; SE 0.11; p = 0.003), cardiac output reserve (beta = 0.24; SE 0.12; p = 0.039), resting E/e' (beta = -0.33; SE 0.11; p = 0.006), and patient frailty expressed by the PRISMA 7 score (beta = -0.30; SE 0.11; p = 0.008). In multivariable analysis including clinical, demographic and cardiac functional variables, SM perfusion reserve was in addition to patient frailty, sex and LV longitudinal strain reserve among the independent correlates of exercise capacity.
SM perfusion reserve is impaired in HFpEF, and is associated with reduced exercise capacity independent of clinical, demographic and "central" cardiac factors. This supports the need to consider the SM domain in patient management strategies in HFpEF.
射血分数保留的心力衰竭（HFpEF）患者运动不耐受的骨骼肌（SM）相关机制尚未完全明确，体力活动期间SM血流量增加不足可能是原因之一。因此，我们试图研究在这种临床情况下，SM对运动的灌注反应与运动能力之间的关联。
对77例纽约心脏协会（NYHA）心功能II级和III级的HFpEF患者以及25例运动耐量正常（B期）的受试者进行了静息状态下以及运动试验后即刻的超声心动图检查和通过超声造影评估的SM微血管灌注。通过运动值减去静息值来计算心脏功能和SM灌注的运动储备。
除了心脏功能储备降低外，与B期心力衰竭患者相比，HFpEF患者的SM灌注储备显著降低，在左心室（LV）舒张功能异常更严重（E/e'>15且三尖瓣反流速度>2.8 m/s）的亚组中，受损程度更大。SM灌注储备与运动能力显著相关（β=0.33；标准误0.11；p=0.003）、心输出量储备（β=0.24；标准误0.12；p=0.039）、静息E/e'（β=-0.33；标准误0.11；p=0.006）以及用PRISMA 7评分表示的患者虚弱程度（β=-0.30；标准误0.11；p=0.008）。在包括临床、人口统计学和心脏功能变量的多变量分析中，除了患者虚弱程度、性别和LV纵向应变储备外，SM灌注储备还是运动能力的独立相关因素。
HFpEF患者的SM灌注储备受损，且与运动能力降低相关，独立于临床、人口统计学和“中心”心脏因素。这支持在HFpEF患者管理策略中考虑SM领域的必要性。
