The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis.
The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis.
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DOI：
10.1097/md.0000000000025128
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发表时间：
2021-04-02
期刊：
影响因子：
1.6
通讯作者：
Cui K
中科院分区：
文献类型：
--
作者：
Guo R;Wen Y;Xu Y;Jia R;Zou S;Lu S;Liu G;Cui K
系统回顾目前发表的关于运动训练（ET）对进行心脏再同步化治疗（CRT）的慢性心力衰竭（CHF）患者的影响的文献。检索PubMed、EMBASE和Cochrane对照试验库数据库，比较截至2020.03.07年，未进行运动或常规护理控制的CRT植入后，ET对CHF患者的额外影响的试验。我们独立筛选文献，提取资料，采用TESTEX （assEssment of Study qualiTy and reporting in EXercise）评估研究质量和偏倚风险，并使用Revman 5.3软件进行meta分析。8项试验进行定性分析，7项随机对照试验（rct）包括235名受试者（120名ET， 115名对照）进行定量分析。结果显示，最大工作量(mean difference [MD] 26.32 W, 95% CI 19.41 ~ 33.23; P <。00001, I2 = 0%)和运动时间(MD 68.95秒，95% CI 15.41 ~ 122.48；01, I2 = 76%)与对照组相比，ET组有显著改善。亚组分析显示，与对照组相比，各组患者的峰值摄氧量（VO2）变化(MD 3.05 ml/kg/min, 95% CI 2.53 ~ 3.56；00001, I2 = 0%)，左室射血分数（LVEF） (MD 4.97%, 95% CI 1.44-8.49；006, I2 = 59%)和健康相关生活质量（HRQoL）(明尼苏达州生活伴心力衰竭问卷[MLHFQ]的变化：MD为- 19.96,95% CI为- 21.57 ~ - 18.34；00001, I2 = 0%)在轻、中强度训练（非HIT）组中有显著改善，而在高强度训练（HIT）组中上述终点无统计学差异。在短期内（最多6个月），非hit可以改善CRT治疗的CHF患者的运动能力、心功能和HRQoL。然而，由于受试者数量少，需要进行高质量的大样本多中心试验。
Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT). PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software. Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41–33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41–122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53–3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44–8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD −19.96, 95% CI −21.57 to −18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group. During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.