Kelley George A, Kelley Kristi S, Stauffer Brian L
School of Public Health, Department of Epidemiology and Biostatistics, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia.
School of Public and Population Health, Boise State University, Boise, Idaho.
JHLT Open. 2023 Dec 9;3:100033. doi: 10.1016/j.jhlto.2023.100033. eCollection 2024 Feb.
Determine whether true exercise-associated interindividual response differences (IIRD) occur in cardiorespiratory fitness as a result of exercise-based cardiac rehabilitation in heart transplant patients.
Using data from a recent (2023) meta-analysis of 9 randomized controlled trials representing 296 patients (163 exercise, 133 control), an aggregate data meta-analysis of treatment effects (change outcome differences between exercise and control groups) was conducted as well as an IIRD meta-analysis using the inverse variance heterogeneity model. The primary outcome was cardiorespiratory fitness (VO) in ml/kg/min.
Statistically significant and clinically important increases equivalent to 14.5% were observed for VO in ml/kg/min ( , 3.0, 95% confidence interval (CI), 2.4-3.7 ml/kg/min, < 0.001; Q = 11.8, = 0.16; = 32.0%, 95% CI, 0%-68.8%; = 0.4). The 95% prediction interval (PI) was 1.2-4.7 ml/kg/min. However, no statistically significant IIRD were observed ( , 0.6, 95% CI, -1.1 to 1.4 ml/kg/min; = 2.9). The 95% PI was -2.7 to 2.8 ml/kg/min.
While exercise-based cardiac rehabilitation increases VO in ml/kg/min in heart transplant patients, a lack of true exercise-associated IIRD exists. A need exists for additional well-designed randomized controlled trials of longer duration to determine the long-term effects of exercise-based cardiac rehabilitation on VO in ml/kg/min heart transplant patients.
确定心脏移植患者在进行运动心脏康复后，心肺适能是否会出现真正的个体间反应差异（IIRD）。
利用近期（2023年）对9项随机对照试验（涉及296名患者，163名运动组，133名对照组）的荟萃分析数据，进行了治疗效果的汇总数据荟萃分析（运动组与对照组之间的结局差异变化）以及使用逆方差异质性模型的IIRD荟萃分析。主要结局是心肺适能（VO），单位为毫升/千克/分钟。
观察到以毫升/千克/分钟为单位的VO有统计学显著且具有临床意义的增加，相当于14.5%（ ，3.0，95%置信区间（CI），2.4 - 3.7毫升/千克/分钟， ＜0.001；Q = 11.8， = 0.16； = 32.0%，95% CI，0% - 68.8%； = 0.4）。95%预测区间（PI）为1.2 - 4.7毫升/千克/分钟。然而，未观察到统计学显著的IIRD（ ，0.6，95% CI， - 1.1至1.4毫升/千克/分钟； = 2.9）。95% PI为 - 2.7至2.8毫升/千克/分钟。
虽然运动心脏康复可提高心脏移植患者以毫升/千克/分钟为单位的VO，但不存在真正的运动相关IIRD。需要进行更多设计良好、持续时间更长的随机对照试验，以确定运动心脏康复对心脏移植患者以毫升/千克/分钟为单位的VO的长期影响。
