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心力衰竭患者对运动和活动反应的生理表型分析

Physiologic Phenotyping of Responses to Exercise and Activity in Heart Failure.

作者信息

Lewis Gregory D, Tada Atsushi, Landsteiner Isabela, Borlaug Barry A

机构信息

Cardiology Division and Cardiovascular Research Center, Massachusetts General Hospital, Boston (G.D.L., I.L.).

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.T., B.A.B.).

出版信息

Circ Res. 2025 Jul 7;137(2):290-315. doi: 10.1161/CIRCRESAHA.125.325534. Epub 2025 Jul 3.


DOI:10.1161/CIRCRESAHA.125.325534
PMID:40608855
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12233139/
Abstract

Subjective and objective limitations to exercise and activity are hallmarks of heart failure (HF), regardless of underlying ejection fraction (EF). These limitations relate to cardiovascular abnormalities involving the systolic and diastolic properties of the heart, venous, and arterial vasculature, as well as noncardiovascular abnormalities, including impairments in pulmonary function, autonomic regulation, anemia, metabolism, and changes in mitochondria and skeletal muscle. The contribution of these abnormalities varies between patients with HF with preserved EF and those with HF with reduced EF, but, even within each HF subtype, there is substantial individual patient pathophysiologic variability, which suggests a potentially important role for phenotyping based on exercise reserve responses to individualize treatment. In this article, we review the current understanding of exercise reserve limitation with a focus on specific organ systems involved, both in patients with HF with preserved EF and HF with reduced EF, and how these interact to lead to symptoms of exercise intolerance and objective limitations in submaximal and peak aerobic capacity across the spectrum of HF.

摘要

无论基础射血分数(EF)如何,运动和活动的主观及客观限制都是心力衰竭(HF)的标志。这些限制与涉及心脏收缩和舒张特性、静脉和动脉血管系统的心血管异常有关,也与非心血管异常有关,包括肺功能损害、自主神经调节、贫血、代谢以及线粒体和骨骼肌的变化。这些异常在射血分数保留的HF患者和射血分数降低的HF患者之间的贡献有所不同,但即使在每种HF亚型内,个体患者的病理生理变异性也很大,这表明基于运动储备反应进行表型分析以个体化治疗可能具有重要作用。在本文中,我们回顾了目前对运动储备限制的理解,重点关注射血分数保留的HF患者和射血分数降低的HF患者中涉及的特定器官系统,以及这些系统如何相互作用导致运动不耐受症状和整个HF范围内次最大和峰值有氧能力的客观限制。

相似文献

[1]
Physiologic Phenotyping of Responses to Exercise and Activity in Heart Failure.

Circ Res. 2025-7-7

[2]
Contribution of reduced skeletal muscle perfusion reserve to exercise intolerance in heart failure with preserved ejection fraction.

Int J Cardiol. 2024-1-15

[3]
Relationship Between Remote, Ambulatory Pulmonary Artery Pressures, and All-Cause Mortality in Patients With Chronic Heart Failure.

Circ Heart Fail. 2025-6

[4]
Inpatient versus outpatient diagnosis of heart failure across the spectrum of ejection fraction: a population cohort study.

Heart. 2025-5-12

[5]
Beta-Blockers for Secondary Prevention following Myocardial Infarction in Patients Without Reduced Ejection Fraction or Heart Failure: An Updated Meta-Analysis.

Eur J Prev Cardiol. 2024-9-20

[6]
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Cochrane Database Syst Rev. 2018-9-19

[7]
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Cochrane Database Syst Rev. 2021-2-3

[8]
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Syst Rev. 2024-11-26

[9]
Determinants of exercise intolerance in heart failure with preserved ejection fraction: A systematic review and meta-analysis.

Int J Cardiol. 2018-1-28

[10]
α-Adrenergic regulation of skeletal muscle blood flow during exercise in patients with heart failure with preserved ejection fraction.

J Physiol. 2024-7

本文引用的文献

[1]
Dapagliflozin and ventilatory control during exercise in heart failure with preserved ejection fraction: the CAMEO-DAPA trial.

Eur Heart J. 2025-4-22

[2]
Potassium Nitrate in Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.

JAMA Cardiol. 2025-3-1

[3]
Prognostic relevance of exercise pulmonary hypertension: results of the multicentre PEX-NET Clinical Research Collaboration.

Eur Respir J. 2024-11-27

[4]
Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity.

N Engl J Med. 2025-1-30

[5]
Effects of tirzepatide on circulatory overload and end-organ damage in heart failure with preserved ejection fraction and obesity: a secondary analysis of the SUMMIT trial.

Nat Med. 2025-2

[6]
Cardiopulmonary Exercise Testing in Advanced Heart Failure Management.

Heart Fail Clin. 2025-1

[7]
Endovascular Ablation of the Greater Splanchnic Nerve in Heart Failure With Preserved Ejection Fraction: The REBALANCE-HF Randomized Clinical Trial.

JAMA Cardiol. 2024-12-1

[8]
Interatrial Shunt Treatment for Heart Failure: The Randomized RELIEVE-HF Trial.

Circulation. 2024-12-10

[9]
Pulmonary hypertension associated with left heart disease.

Eur Respir J. 2024-10

[10]
GLP-1 Receptor Agonists Among Patients With Overweight or Obesity, Diabetes, and HFpEF on SGLT2 Inhibitors.

JACC Heart Fail. 2024-11

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