Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial.
Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial.
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DOI：
10.1097/00008483-200011000-00015
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发表时间：
2000-11
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影响因子：
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通讯作者：
R. Hambrecht;S. Gielen;A. Linke;E. Fiehn;Jiangtao Yu;C. Walther;N. Schoene;G. Schuler
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文献类型：
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作者：
R. Hambrecht;S. Gielen;A. Linke;E. Fiehn;Jiangtao Yu;C. Walther;N. Schoene;G. Schuler
慢性心力衰竭患者的运动训练通过增强内皮功能和骨骼肌有氧代谢来提高工作能力，但对中枢血流动力学功能的影响尚未得到很好的证实。目的探讨运动训练对稳定型慢性心力衰竭患者左心室功能及运动后血流动力学反应的影响。设计1994-1999年进行前瞻性随机试验。德国大学心内科/门诊。患者：73例70岁或以下慢性心力衰竭（左室射血分数约为0.27）男性的连续样本。干预患者被随机分配到2周，每天4到6次，每次10分钟的住院测力仪运动，随后6个月，每天20分钟，达到峰值摄氧量的70% （n=36）或不进行干预（对照组，n=37）。主要观察指标：人体肺活量测定法在休息和运动时用热调节法测量中枢血流动力学；超声心动图测定运动训练组与对照组在基线和6个月随访时的左室直径和容积。结果6个月后，与对照组相比，运动训练组患者在纽约心脏协会功能分类、最大通气量、运动时间和运动能力方面有统计学显著改善，静息心率降低，静息时卒中量增加。在运动训练组，从基线到随访6个月，平均静息左室射血分数（SD）增加（0.30 [0.08]vs 0.35 [0.09]； P= 0.003）。运动训练组峰值运动时平均（SD）总外周阻力（TPR）减少157（306）达因/秒/厘米（-5），对照组增加43（148）达因/秒/厘米（-5）（P= 0.003），同时平均（SD）卒中容量增加14 (22)mL，对照组增加1 (19)mL （P= 0.03）。对照组左室舒张末期平均直径（SD）减少4 (6)mm，而对照组增加1 (4)mm，差异有统计学意义（P< 0.001）。两组静息TPR与基线的变化均与卒中容量（r=-0.76； P< 0.001）和左室舒张末期直径（r=0.45； P< 0.001）的变化相关。结论：在稳定性慢性心力衰竭患者中，运动训练与外周阻力的降低有关，并可导致小但显著的卒中容量改善和心脏肥大的减少。《美国医学协会杂志》上。2000.
CONTEXT Exercise training in patients with chronic heart failure improves work capacity by enhancing endothelial function and skeletal muscle aerobic metabolism, but effects on central hemodynamic function are not well established. OBJECTIVE To evaluate the effects of exercise training on left ventricular (LV) function and hemodynamic response to exercise in patients with stable chronic heart failure. DESIGN Prospective randomized trial conducted in 1994-1999. SETTING University department of cardiology/outpatient clinic in Germany. PATIENTS Consecutive sample of 73 men aged 70 years or younger with chronic heart failure (with LV ejection fraction of approximately 0.27). INTERVENTION Patients were randomly assigned to 2 weeks of in-hospital ergometer exercise for 10 minutes 4 to 6 times per day, followed by 6 months of home-based ergometer exercise training for 20 minutes per day at 70% of peak oxygen uptake (n=36) or to no intervention (control group; n=37). MAIN OUTCOME MEASURES Ergospirometry with measurement of central hemodynamics by thermodilution at rest and during exercise; echocardiographic determination of LV diameters and volumes, at baseline and 6-month follow-up, for the exercise training vs control groups. RESULTS After 6 months, patients in the exercise training group had statistically significant improvements compared with controls in New York Heart Association functional class, maximal ventilation, exercise time, and exercise capacity as well as decreased resting heart rate and increased stroke volume at rest. In the exercise training group, an increase from baseline to 6-month follow-up was observed in mean (SD) resting LV ejection fraction (0.30 [0.08] vs 0.35 [0.09]; P=.003). Mean (SD) total peripheral resistance (TPR) during peak exercise was reduced by 157 (306) dyne/s/cm(-5) in the exercise training group vs an increase of 43 (148) dyne/s/cm(-5) in the control group (P=.003), with a concomitant increase in mean (SD) stroke volume of 14 (22) mL vs 1 (19) mL in the control group (P=.03). There was a small but significant reduction in mean (SD) LV end diastolic diameter of 4 (6) mm vs an increase of 1 (4) mm in the control group (P<.001). Changes from baseline in resting TPR for both groups were correlated with changes in stroke volume (r=-0.76; P<.001) and in LV end diastolic diameter (r=0.45; P<.001). CONCLUSIONS In patients with stable chronic heart failure, exercise training is associated with reduction of peripheral resistance and results in small but significant improvements in stroke volume and reduction in cardiomegaly. JAMA. 2000.