Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada.
Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France.
Scand J Med Sci Sports. 2024 Apr;34(4):e14633. doi: 10.1111/sms.14633.
In patients with coronary heart disease (CHD), individualized exercise training (ET) programs are strongly recommended to optimize peak oxygen uptake ( O) improvement and prognosis. However, the cardiac hemodynamic factors responsible for a positive response to training remain unclear. The aim of this study was to compare cardiac hemodynamic changes after an ET program in responder (R) versus non-responder (NR) CHD patients.
A total of 72 CHD patients completed a 3-month ET program and were assessed by cycle ergometer cardiopulmonary exercise test (CPET: O assessment) with impedance cardiography (ICG) for hemodynamic measurements before and after training. Cardiac hemodynamics (e.g., CO, CI, SV, ESV, EDV, and SVR) were measured by ICG during CPET. The R and NR groups were classified using the median change in O (>the median for R and ≤the median for NR).
In the R group, O (+17%, p < 0.001), CO, CI, SV, and HR increased by 17%, 17%, 13%, and 5%, respectively (p < 0.05) after the training program. In the NR group, O, CO, CI, and SV increased by 0.5%, 5%, 8%, and 6%, respectively (p < 0.01). The SVR decreased in both groups (-19% in R and -11% in NR, p < 0.001).
Among CHD patients, the R group showed a better improvement in peak cardiac output via an increase in peak stroke volume and heart rate and a reduced systemic vascular resistance than the NR group. Different cardiac phenotype adaptations and clinical individual responses were identified in CHD patients according to the aerobic fitness responder's status.
在冠心病（CHD）患者中，强烈推荐个体化运动训练（ET）方案，以优化峰值摄氧量（ O）的改善和预后。然而，导致对训练产生积极反应的心脏血液动力学因素仍不清楚。本研究旨在比较 ET 方案后反应者（R）与非反应者（NR）CHD 患者的心脏血液动力学变化。
共 72 例 CHD 患者完成了 3 个月的 ET 方案，并通过阻抗心动图（ICG）进行心肺运动测试（CPET： O评估）进行评估，以进行血液动力学测量，在训练前后。在 CPET 期间，通过 ICG 测量心脏血液动力学（例如，CO、CI、SV、ESV、EDV 和 SVR）。使用 O 的中位数变化（>R 的中位数且≤NR 的中位数）将 R 和 NR 组分类。
在 R 组中， O 增加了 17%（p < 0.001），CO、CI、SV 和 HR 分别增加了 17%、17%、13%和 5%（p < 0.05）。在 NR 组中， O、CO、CI 和 SV 分别增加了 0.5%、5%、8%和 6%（p < 0.01）。两组的 SVR 均降低（R 组降低 19%，NR 组降低 11%，p < 0.001）。
在 CHD 患者中，与 NR 组相比，R 组通过增加峰值心输出量、心率和降低全身血管阻力，表现出更好的峰值心输出量改善。根据有氧健身反应者的状态，CHD 患者的心脏表型适应性和临床个体反应不同。
