Kirsch Marine, Iliou Marie-Christine, Vitiello Damien
Institut des Sciences du Sport Sante de Paris (I3SP), URP 3625, Universite Paris Cite, Paris 75015, France.
Department of Cardiac Rehabilitation and Secondary Prevention, Hopital Corentin Celton, APHP Centre, France.
Cardiol Res. 2024 Feb;15(1):18-28. doi: 10.14740/cr1591. Epub 2024 Feb 28.
Supervised exercise training decreases total and cardiac mortality and increases quality of life of heart failure with reduced ejection fraction (HFrEF) patients. However, response to training is variable from one patient to another and factors responsible for a positive response to training remain unclear. The aims of the study were to compare cardiac hemodynamic changes after an exercise training program in responders (R) versus non-responders (NR) HFrEF patients, and to compare different discriminators used to assess response to training.
Seventy-six HFrEF patients (86% males, 57 ± 12 years) completed an exercise training program for 4 weeks. Patients underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer before and after training. Cardiac hemodynamics were measured by impedance cardiography during CPET. The R and NR groups were classified using the median change in peak oxygen uptake (V̇O).
There were statistically significant differences in V̇O (+35% vs. -1%, P < 0.0001) and in peaks of ventilation (+30% vs. +2%, P < 0.0001), cardiac output (CO) (+25% vs. +4%, P < 0.01), systolic blood pressure (+12% vs. +2%, P < 0.05), diastolic blood pressure (+9% vs. +4%, P < 0.05) and heart rate (+8% vs. +1%, P < 0.01) between R and NR after the training program. V̇O was the best discriminator between R and NR (receiver operating characteristic (ROC) area under the curve (AUC) = 0.83, P < 0.0001), followed by CO (ROC AUC = 0.77, P < 0.0001).
V̇O is the best discriminator between HFrEF R and NR patients after the training program. Responders showed improvements in peak hemodynamic parameters. These results pave the way for other studies to determine how the individualization of exercise training programs and peak hemodynamic parameters potentially linked to a better positive response status.
有监督的运动训练可降低射血分数降低的心力衰竭（HFrEF）患者的全因死亡率和心脏死亡率，并提高其生活质量。然而，患者对训练的反应因人而异，对训练产生积极反应的相关因素仍不清楚。本研究的目的是比较运动训练计划后反应者（R）与无反应者（NR）HFrEF患者的心脏血流动力学变化，并比较用于评估训练反应的不同判别指标。
76例HFrEF患者（86%为男性，年龄57±12岁）完成了为期4周的运动训练计划。患者在训练前后在功率自行车上进行心肺运动测试（CPET）。在CPET期间通过阻抗心动图测量心脏血流动力学。根据峰值摄氧量（V̇O）的中位数变化对R组和NR组进行分类。
训练计划后，R组和NR组在V̇O（+35%对 -1%，P < 0.0001）、通气峰值（+30%对 +2%，P < 0.0001）、心输出量（CO）（+25%对 +4%，P < 0.01）、收缩压（+12%对 +2%，P < 0.05）、舒张压（+9%对 +4%，P < 0.05）和心率（+8%对 +1%，P < 0.01）方面存在统计学显著差异。V̇O是R组和NR组之间最好的判别指标（受试者工作特征（ROC）曲线下面积（AUC） = 0.83，P < 0.0001），其次是CO（ROC AUC = 0.77，P < 0.0001）。
V̇O是训练计划后HFrEF反应者和无反应者之间最好的判别指标。反应者的血流动力学峰值参数有所改善。这些结果为其他研究确定运动训练计划的个体化以及可能与更好的积极反应状态相关的血流动力学峰值参数铺平了道路。
