Muscle fatigue and dyspnoea in chronic heart failure: two sides of the same coin?
Muscle fatigue and dyspnoea in chronic heart failure: two sides of the same coin?
复制标题
慢性心力衰竭的肌肉疲劳和呼吸困难：同一枚硬币的两个方面？
作者：
A. Clark;J. Sparrow;A. Coats
慢性心力衰竭患者的限制性症状，呼吸急促和运动疲劳的发病机制知之甚少。我们分析了222例递增症状限制性运动试验的数据，以确定因呼吸困难或疲劳而停止的患者之间是否存在差异。160例患者因呼吸困难而停止，62例因疲劳而停止。两组之间的基础诊断或运动能力无差异（疲劳组的峰值耗氧量为15.66（+/- 5.62）ml.kg-1.min-1，呼吸困难组为15.13（+/- 4.64））。通过对二氧化碳产生的呼吸反应（VE/VCO 2斜率）评估的呼吸反应在两组之间没有差异（疲劳组为2.61（+/- 0.96），呼吸困难组为3.03（+/- 1.23）：P = ns）。两组之间的左心室尺寸、左心室射血分数或左心室舒张末期压无差异。慢性心力衰竭的呼吸困难和疲劳的限制性症状是同一枚硬币的两面。任何对慢性心力衰竭运动受限的病理生理学解释都必须将这两种症状统一起来。
The pathogenesis of the limiting symptoms in patients with chronic heart failure, shortness of breath and fatigue on exercise, are poorly understood. We analysed data from 222 incremental symptom limited exercise tests to determine whether there were differences between patients stopped by breathlessness or fatigue. One hundred and sixty patients were stopped by breathlessness and 62 by fatigue. There was no differences between the two groups in underlying diagnosis or in exercise performance (peak oxygen consumption 15.66 (+/- 5.62) ml.kg-1.min-1 in the fatigue group, 15.13 (+/- 4.64) in the breathless group). The ventilatory response as assessed by ventilatory response to carbon dioxide production (VE/VCO2 slope) was not different between the two groups (2.61 (+/- 0.96) in the fatigue group, 3.03 (+/- 1.23) in the breathless group: P = ns). There were no differences between the two groups in left ventricular dimensions, left ventricular ejection fraction or left ventricular end-diastolic pressure. The limiting symptoms of breathlessness and fatigue in chronic heart failure are two sides of the same coin. Any pathophysiological explanation of exercise limitation in chronic heart failure must unify these two symptoms.