心肌病中心血管危险因素的发生率及运动表型分析：并非一概而论。

Incidence of cardiovascular risk factors and exercise phenotyping in cardiomyopathies: One size does not fit all.

作者信息

Wernhart Simon, Karcher Florian, Haykowsky Mark J, Halle Martin

机构信息

Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, Technical University Munich (TUM), Klinikum rechts der Isar, Munich, Germany.

DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.

出版信息

Int J Cardiol Heart Vasc. 2025 Jun 17;59:101722. doi: 10.1016/j.ijcha.2025.101722. eCollection 2025 Aug.

DOI:10.1016/j.ijcha.2025.101722

PMID:40599641

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12210320/

Abstract

BACKGROUND

Cardiovascular disease risk factors (CVDRF) are linked to increased morbidity in cardiomyopathies (CMP), but whether new onset CVDRF differ among CMPs is unknown. In addition, whether the acute exercise response during cardiopulmonary exercise testing (CPET) differs among CMPs remains unclear.

METHODS

This single-center, retrospective study analyzed patients with arrhythmogenic, hypertrophic, and dilated (DCM) cardiomyopathy without CVDRF at baseline. Resting echocardiography and CPET were performed, and exercise response was assessed depending on sex and CMP. After a median follow-up of 19.5 months, CPET and echocardiography were analyzed in relation to the development of new CVDRF.

RESULTS

A total of 104 CMPs were included (median age 53.0 years). New-onset CVDRF was rare (11.5 %) and driven by arterial hypertension (8.7 %) but did not differ among CMPs. DCM displayed significantly lower resting left ventricular ejection fraction (40.5 %, interquartile range, IQR, 11.5 %, p < 0.001), diastolic function (E/e' 9.3, IQR 5.5, p < 0.001), and had the lowest peak systolic blood pressure (170.0 mmHg, IQR 52.5 mmHg, p = 0.011), predicted peak oxygen consumption (82.0 %, IQR 39.8 %, p = 0.003), oxygen pulse (101.0 %, IQR 28.8 %, p = 0.030) as well as lower ventilatory (VP, 5.5 mmHg, IQR 1.4 mmHg, p = 0.033) and circulatory (CP, 4096.0 mL/kg/min x mmHg, IQR 2299.3 mL/kg/min x mmHg, p = 0.015) power compared to the other groups. Lower VP (5.0 mmHg, IQR 1.3 mmHg, p = 0.003) and CP (3660.0 mL/kg/min x mmHg, IQR 3298.0 mL/kg/min x mmHg, p = 0.004) were observed for females.

CONCLUSIONS

Arterial hypertension was the most common CVDRF among CMPs, underscoring the importance of monitoring this outcome. Exercise limitations differ between CMPs and should be interpreted depending on sex.

摘要

背景

心血管疾病危险因素（CVDRF）与心肌病（CMP）发病率增加有关，但新发CVDRF在不同类型的CMP中是否存在差异尚不清楚。此外，心肺运动试验（CPET）期间的急性运动反应在不同类型的CMP中是否存在差异仍不明确。

方法

本单中心回顾性研究分析了基线时无CVDRF的致心律失常性、肥厚性和扩张型（DCM）心肌病患者。进行了静息超声心动图和CPET检查，并根据性别和CMP评估运动反应。在中位随访19.5个月后，分析CPET和超声心动图与新发CVDRF的发生情况。

结果

共纳入104例CMP患者（中位年龄53.0岁）。新发CVDRF很少见（11.5%），主要由动脉高血压（8.7%）引起，但在不同类型的CMP中无差异。DCM的静息左心室射血分数显著较低（40.5%，四分位间距，IQR，11.5%，p<0.001），舒张功能（E/e' 9.3，IQR 5.5，p<0.001），且收缩压峰值最低（170.0 mmHg，IQR 52.5 mmHg，p = 0.011），预测的峰值耗氧量（82.0%，IQR 39.8%，p = 0.003），氧脉搏（101.0%，IQR 28.8%，p = 0.030），以及与其他组相比更低的通气（VP，5.5 mmHg，IQR 1.4 mmHg，p = 0.033）和循环（CP，4096.0 mL/kg/min x mmHg，IQR 2299.3 mL/kg/min x mmHg，p = 0.015）功率。女性的VP（5.0 mmHg，IQR 1.3 mmHg，p = 0.003）和CP（3660.0 mL/kg/min x mmHg，IQR 3298.0 mL/kg/min x mmHg，p = 0.004）较低。