Lewis Gregory D, Tada Atsushi, Landsteiner Isabela, Borlaug Barry A
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.).
Circ Res. 2025 Jul 7;137(2):290-315. doi: 10.1161/CIRCRESAHA.125.325534. Epub 2025 Jul 3.
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.
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。
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