Beneficial effects of exercise training on physical performance in patients with vasospastic angina
Beneficial effects of exercise training on physical performance in patients with vasospastic angina
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运动训练对血管痉挛性心绞痛患者身体机能的有益影响
DOI：
10.1016/j.ijcard.2020.12.003
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发表时间：
2021
影响因子：
3.5
通讯作者：
Sugisawa Jun,Matsumoto Yasuharu,Takeuchi Masashi,Suda Akira,Tsuchiya Satoshi,Ohyama Kazuma,Nishimiya Kensuke,Akizuki Mina,Sato Koichi,Ohura Shoko,Ota Hideki,Ikeda Shohei,Shindo Tomohiko,Kikuchi Yoku,Hao Kiyotaka,Shiroto Takashi,Takahashi Jun,Miyata Satosh
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文献类型：
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作者：
Niwayama Marie;Sakisaka Kayako;Wongwatcharapaiboon Pongthep;Rattanachun Valika;Miyata Satoshi;Takahashi Kenzo;Sugisawa Jun,Matsumoto Yasuharu,Takeuchi Masashi,Suda Akira,Tsuchiya Satoshi,Ohyama Kazuma,Nishimiya Kensuke,Akizuki Mina,Sato Koichi,Ohura Shoko,Ota Hideki,Ikeda Shohei,Shindo Tomohiko,Kikuchi Yoku,Hao Kiyotaka,Shiroto Takashi,Takahashi Jun,Miyata Satosh
目的在血管痉挛性心绞痛（VSA）中，冠状动脉血管舒缩异常不仅可能发生在心外膜冠状动脉中，而且可能发生在冠状微血管中，而钙通道阻滞剂（CCB）在冠状动脉微血管中的疗效有限。然而，运动训练对 VSA 的功效仍有待阐明。因此，我们的目的是检查 VSA 患者冠状动脉微血管的血管舒张能力是否受损，如果受损，运动是否对 CCB 顶部产生有益影响。方法我们进行了 2 种临床方案。在方案 1 中，我们使用腺苷应激动态计算机断层扫描灌注 (CTP) 测量了 38 名连续 VSA 患者和 17 名非 VSA 对照者的心肌血流量 (MBF)。在方案 2 中，我们进行了随机对照试验，其中 20 名 VSA 患者被随机分配到 3 个月的运动训练组（运动组）或非运动组（每组 n = 10）。结果在方案 1 中，与非 VSA 组相比，VSA 组 CTP 上的 MBF 显着降低（138 ± 6 vs 166 ± 10 毫升/100 克/分钟，P= 0.02）。在方案2中，运动组的运动能力显着高于非运动组（11.5±0.5至15.4±1.8 vs 12.6±0.7至14.0±0.8ml/min/kg，P<0.01）。 3个月后，仅运动组的MBF也显着改善（运动组，145±12至172±8ml/100g/min，P<0.04；非运动组，143±14至167±8ml/100g/min，P=0.11），尽管组间没有显着性差异结论这些结果提供了第一个证据，表明在 VSA 患者中，CCB 治疗基础上的运动训练可能有助于改善身体机能，尽管其对 MBF 的影响可能很小。
AimsIn vasospastic angina (VSA), coronary vasomotion abnormalities could develop not only in epicardial coronary arteries but also in coronary microvessels, where calcium channel blockers (CCBs) have limited efficacy. However, efficacy of exercise training for VSA remains to be elucidated. We thus aimed to examine whether vasodilator capacity of coronary microvessels is impaired in VSA patients, and if so, whether exercise exerts beneficial effects on the top of CCBs.MethodsWe performed 2 clinical protocols. In the protocol 1, we measured myocardial blood flow (MBF) using adenosine-stress dynamic computed tomography perfusion (CTP) in 38 consecutive VSA patients and 17 non-VSA controls. In the protocol 2, we conducted randomized controlled trial, where 20 VSA patients were randomly assigned to either 3-month exercise training group (Exercise group) or Non-Exercise group (n= 10 each).ResultsIn the protocol 1, MBF on CTP was significantly decreased in the VSA group compared with the Non-VSA group (138 ± 6 vs 166 ± 10 ml/100 g/min,P= 0.02). In the protocol 2, exercise capacity was significantly increased in the Exercise group than in the Non-Exercise group (11.5 ± 0.5 to 15.4 ± 1.8 vs 12.6 ± 0.7 to 14.0 ± 0.8 ml/min/kg,P< 0.01). MBF was also significantly improved after 3 months only in the Exercise group (Exercise group, 145 ± 12 to 172 ± 8 ml/100 g/min,P< 0.04; Non-Exercise group, 143 ± 14 to 167 ± 8 ml/100 g/min,P= 0.11), although there were no significant between-group differences.ConclusionsThese results provide the first evidence that, in VSA patients, exercise training on the top of CCBs treatment may be useful to improve physical performance, although its effect on MBF may be minimal.