Duarte Fabiana, Ricardo Inês, Faria Clarissa, Alves da Silva Pedro, Cunha Nelson, Miguel Sandra, Pinto Rita, Pinto Fausto, Abreu Ana
Hospital of Divino Espírito Santo, Ponta Delgada, Portugal.
Cardiology Service, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal.
Cardiology. 2025;150(2):203-209. doi: 10.1159/000541011. Epub 2024 Aug 27.
Exercise-based cardiac rehabilitation programs (CRPs) represent a multidisciplinary therapeutic approach tailored to improve cardiorespiratory fitness and overall health-related quality of life, while reducing cardiovascular hospitalizations and mortality. Our aim was to determine changes in exercise capacity and cardiac events according to the left ventricular ejection fraction (LVEF) following a CRP.
This single-center cohort study included 131 patients who completed a center-based CRP from 2015 to 2022. Cardiopulmonary exercise testing (CPET), transthoracic echocardiography, and laboratory analysis were performed before and after program completion.
Of 232 enrolled patients, 131 were included in our cohort analysis, with 36.6% having a reduced LVEF. These patients exhibited higher rates of atrial fibrillation (p = 0.019) and NT-proBNP values (p < 0.001). Patients with reduced LVEF had lower peak VO2 (pVO2) (p = 0.046), percentage of predicted oxygen consumption (ppVO2) (p < 0.001), and VO2 at anaerobic threshold (p = 0.015) during baseline CPET. Completion of the CRP led to comparable improvements in exercise performance between groups, assessed through Δ pVO2 (p = 0.990), Δ ppVO2 (p = 0.610), and Δ VE/VCO2 slope (p = 0.200). In the study population, male gender and hypertension independently predicted variation in VE/VCO2 slope (p = 0.017) and oxygen uptake efficiency slope (p = 0.048), respectively, post-CRP. During follow-up, 9.2% of all patients had hospital admissions for cardiac events, and 3.8% died, with no significant differences between groups.
Patients with reduced LVEF admitted to our CRP showed lower functional status based on specific CPET parameters. After CRP, both reduced and preserved LVEF groups experienced similar functional improvements. Therefore, strategies to increase participation of patients with reduced LVEF in such programs are warranted.
基于运动的心脏康复计划（CRP）是一种多学科治疗方法，旨在提高心肺功能和与整体健康相关的生活质量，同时减少心血管疾病住院率和死亡率。我们的目的是确定CRP后根据左心室射血分数（LVEF）的运动能力和心脏事件的变化。
这项单中心队列研究纳入了2015年至2022年期间完成中心CRP的131例患者。在项目完成前后进行心肺运动试验（CPET）、经胸超声心动图检查和实验室分析。
在232例登记患者中，131例纳入我们的队列分析，其中36.6%的患者LVEF降低。这些患者表现出较高的房颤发生率（p = 0.019）和N末端脑钠肽前体（NT-proBNP）值（p < 0.001）。LVEF降低的患者在基线CPET期间的峰值VO₂（pVO₂）（p = 0.046）、预测耗氧量百分比（ppVO₂）（p < 0.001）和无氧阈值时的VO₂（p = 0.015）较低。通过ΔpVO₂（p = 0.990）、ΔppVO₂（p = 0.610）和ΔVE/VCO₂斜率（p = 0.200）评估，CRP的完成导致两组之间运动表现的改善相当。在研究人群中，男性和高血压分别独立预测CRP后VE/VCO₂斜率（p = 0.017）和摄氧效率斜率（p = 0.048）的变化。在随访期间，所有患者中有9.2%因心脏事件入院，3.8%死亡，两组之间无显著差异。
纳入我们CRP的LVEF降低的患者基于特定CPET参数显示出较低的功能状态。CRP后，LVEF降低组和保留组的功能改善相似。因此，有必要采取策略提高LVEF降低患者参与此类计划的比例。
