射血分数保留的心力衰竭（HFpEF）和射血分数中间范围的心力衰竭（HFmrEF）纽约心脏协会（NYHA）III级患者每日体力活动与肺动脉压的关联：一项试点试验——可行性及初步结果
Association of daily physical activity with pulmonary artery pressure in HFpEF and HFmrEF NYHA class III patients: a pilot trial-feasibility and first results.
作者信息
Herrmann Ester J, Lange Denise, Hannig Jennifer, Zimmer Gina, Gruen Dimitri, Keller Till, Edegran Albin, Johnson Linda S, Sossalla Samuel, Guckert Michael, Assmus Birgit
机构信息
Department of Medicine I, Cardiology and Angiology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstr. 33, 35392, Giessen, Germany.
Institute of Mathematics, Natural Sciences and Data Processing, Technische Hochschule Mittelhessen, University of Applied Sciences, 61169, Friedberg, Germany.
出版信息
Clin Res Cardiol. 2024 Nov 7. doi: 10.1007/s00392-024-02564-6.
INTRODUCTION
Supervised physical exercise has been shown to benefit patients with heart failure with preserved/mildly reduced ejection fraction (HFpEF/HfmrEF) by improving symptoms and diastolic function. This study aimed to investigate the correlation between unsupervised daily physical activity and changes in daily pulmonary artery pressure (PAP) in patients with stable NYHA class III heart failure (HF) and left ventricular ejection fraction (LVEF) of 45% or higher.
METHODS
Daily physical activity was monitored over a 3-month period using a Holter-ECG with an accelerometer that calculated an activity-associated, heart rate-derived metabolic equivalent of task (MET) score. PAP was measured using an implanted sensor in 17 patients.
RESULTS
During 3 months of PAP monitoring in parallel with Holter ECG in our HF patients (median age 77 [IQR 72-79.5] years, LVEF 55 [49-56] %, mean cardiac index 1.9 ± 0.3), mean, diastolic, and systolic PAP remained unchanged. Patients engaged in unsupervised daily activity with a mean MET score of 5.0 ± 1.2 and a median daily duration of 41 [13-123] minutes. Intensity of daily activity was associated with a higher diastolic PAP on the following day (R = 0.017, p = 0.003), particularly in female patients and those with pulmonary hypertension (PH) (female: R = 0.044, p = 0.002; PH: R = 0.024, p = 0.004). Patients with longer daily activity durations had lower systolic and mean PAP (p = 0.038 and p = 0.048) and a similar diastolic PAP (p = 0.053) after 3 months.
CONCLUSIONS
Tracking changes in daily PAP based on intensity and duration of unsupervised daily activity using implanted sensors and a PocketECG is feasible. While daily activity duration was not directly linked to diastolic PAP on the first day after daily activity, intensity, especially in female and PH patients, was associated with increased diastolic PAP. In addition, longer daily activity, rather than higher intensity, might be more important for lowering PAP in the long term. Further research in larger trials is warranted to confirm these findings.
引言
有监督的体育锻炼已被证明可改善射血分数保留/轻度降低的心力衰竭（HFpEF/HfmrEF）患者的症状和舒张功能，从而使他们受益。本研究旨在调查纽约心脏病协会（NYHA）心功能Ⅲ级稳定型心力衰竭（HF）且左心室射血分数（LVEF）为45%或更高的患者，其日常无监督身体活动与每日肺动脉压（PAP）变化之间的相关性。
方法
在3个月期间，使用带有加速度计的动态心电图监测日常身体活动，该加速度计可计算与活动相关的、基于心率的代谢当量任务（MET）得分。对17例患者使用植入式传感器测量PAP。
结果
在我们的HF患者（中位年龄77[四分位间距72 - 79.5]岁，LVEF 55[49 - 56]%，平均心脏指数1.9±0.3）中，与动态心电图并行进行PAP监测的3个月期间，平均、舒张期和收缩期PAP保持不变。患者进行无监督的日常活动，平均MET得分为5.0±1.2，每日持续时间中位数为41[13 - 123]分钟。日常活动强度与次日较高的舒张期PAP相关（R = 0.017，p = 0.003），尤其是在女性患者和患有肺动脉高压（PH）的患者中（女性：R = 0.044，p = 0.002；PH：R = 0.024，p = 0.004）。日常活动持续时间较长的患者在3个月后收缩期和平均PAP较低（p = 0.038和p = 0.048），舒张期PAP相似（p = 0.053）。
结论
使用植入式传感器和袖珍心电图根据无监督日常活动的强度和持续时间追踪每日PAP的变化是可行的。虽然日常活动持续时间在日常活动后的第一天与舒张期PAP没有直接关联，但强度，尤其是在女性和PH患者中，与舒张期PAP升高相关。此外，从长期来看，较长的日常活动时间而非较高的强度可能对降低PAP更重要。需要在更大规模的试验中进行进一步研究以证实这些发现。
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