Sullivan M J, Hawthorne M H
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Prog Cardiovasc Dis. 1995 Jul-Aug;38(1):1-22. doi: 10.1016/s0033-0620(05)80011-8.
Patients with chronic heart failure (CHF) experience significant morbidity because of dyspnea and fatigue with activities of daily living. Although central hemodynamic abnormalities are the hallmark of this disorder, investigators have not shown a relationship between left ventricular ejection fraction or exercise pulmonary capillary wedge pressure and exercise intolerance in this disorder. Recent studies have focused on the contributions of pulmonary abnormalities and alterations in peripheral vasomotor control and skeletal muscle in exercise intolerance in this disorder. Early anaerobic metabolism occurs in patients with CHF and appears to be caused by a combination of reduced skeletal muscle blood flow and decreased aerobic enzyme content in skeletal muscle. Atrophy in skeletal muscle and alterations in skeletal muscle fiber typing are accompanied by alterations in contractile function in skeletal muscle. These results suggest that exercise intolerance in patients with CHF is multifactorial, and that research efforts must consider central hemodynamic abnormalities, pulmonary abnormalities, and alterations in peripheral blood flow and skeletal muscle biochemistry and histology. The present review will explore current research in this area and develop a model for understanding exercise intolerance in CHF.
慢性心力衰竭（CHF）患者因日常生活活动中的呼吸困难和疲劳而出现明显的发病率。尽管中心血流动力学异常是这种疾病的标志，但研究人员尚未证明左心室射血分数或运动时肺毛细血管楔压与这种疾病中的运动不耐受之间存在关联。最近的研究集中在肺部异常以及外周血管运动控制和骨骼肌改变在这种疾病运动不耐受中的作用。CHF患者会出现早期无氧代谢，这似乎是由骨骼肌血流减少和骨骼肌中有氧酶含量降低共同导致的。骨骼肌萎缩和骨骼肌纤维类型改变伴随着骨骼肌收缩功能的改变。这些结果表明，CHF患者的运动不耐受是多因素的，并且研究工作必须考虑中心血流动力学异常、肺部异常以及外周血流和骨骼肌生物化学及组织学的改变。本综述将探讨该领域的当前研究，并建立一个理解CHF运动不耐受的模型。
