Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: Arterial Stiffness and Aabnormal Left Ventricular Hemodynamic Responses During Exercise.
Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: Arterial Stiffness and Aabnormal Left Ventricular Hemodynamic Responses During Exercise.
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锻炼心力衰竭的耐耐受性，并保留了射血分数：运动过程中动脉刚度和敏感性左心室血液动力学反应。
DOI：
10.1016/j.cardfail.2021.02.011
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发表时间：
2021-06
影响因子：
6
通讯作者：
Lewis GD
中科院分区：
文献类型：
--
作者：
Zern EK;Ho JE;Panah LG;Lau ES;Liu E;Farrell R;Sbarbaro JA;Schoenike MW;Pappagianopoulos PP;Namasivayam M;Malhotra R;Nayor M;Lewis GD
动脉僵硬被认为与射血分数保留的心力衰竭(HFpEF)的病理生理有关。我们试图检测HFpEF和高血压患者的动脉僵硬程度，并调查运动对动脉和左心室血流动力学反应的相关性。对385例EF≥为50%的有症状个体进行立位心肺运动试验，有创血流动力学评价静息和递增负荷时的动脉僵硬和负荷(主动脉增压、增厚指数、全身血管阻力指数、总动脉顺应性指数、有效动脉弹性指数和脉压放大)。运动引起的异常血流动力学反应被定义为肺毛细血管楔压相对于心输出量的急剧增加(Δ、PCWP/Δ、CO>；2毫米汞/L/分钟)。我们在多变量分析中比较了HFpEF和高血压患者的休息和运动措施。在188名高血压病患者(年龄61±13岁，56%为女性)中，与94名高血压患者(年龄55岁±15岁，女性52%)相比，静息动脉僵硬参数更差；这些差异在高血压病患者的运动过程中更加明显(均p≤0.0001)。在所有参与者中，运动测量的动脉僵硬与较差的ΔPCWP/ΔCO相关。具体地说，1-SD较高的运动增强压力与左心室血流动力学反应异常的几率增加2.15倍相关(95%可信区间1.52-3.05，p<；0.001)。此外，运动测量的全身血管阻力指数、弹性指数和脉压放大与较低的峰值VO2相关。运动加剧了HFpEF中动脉僵硬的升高，而这反过来又与左室血流动力学反应相关。HFpEF运动过程中不良的心室-血管相互作用可能会导致运动不耐受，并为未来的治疗干预提供参考。与高血压患者相比，与高血压患者相比，射血分数保持不变的心力衰竭患者的动脉僵硬和负荷随着运动的增加而加重，并与直立递增运动的左心室血流动力学反应相关。心力衰竭患者在固定的自行车上锻炼，同时我们测量了他们的心肺功能和血压。与高血压患者相比，心力衰竭患者的血管更硬。血管僵硬可能与心力衰竭患者呼吸短促和运动困难有关。
Arterial stiffness is thought to contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). We sought to examine arterial stiffness in HFpEF and hypertension and investigate associations of arterial and left ventricular hemodynamic responses to exercise. A total of 385 symptomatic individuals with EF ≥ 50% underwent upright cardiopulmonary exercise testing with invasive hemodynamic assessment of arterial stiffness and load (aortic augmentation pressure, augmentation index, systemic vascular resistance index, total arterial compliance index, effective arterial elastance index, and pulse pressure amplification) at rest and during incremental exercise. An abnormal hemodynamic response to exercise was defined as a steep increase in pulmonary capillary wedge pressure relative to cardiac output (ΔPCWP/ΔCO > 2 mmHg/L/min). We compared rest and exercise measures between HFpEF and hypertension in multivariable analyses. Among 188 HFpEF participants (age 61±13, 56% women), resting arterial stiffness parameters were worse compared to 94 hypertensive participants (age 55 ± 15, 52% women); these differences were accentuated during exercise in HFpEF (all p≤0.0001). Among all participants, exercise measures of arterial stiffness correlated with worse ΔPCWP/ΔCO. Specifically, a 1-SD higher exercise augmentation pressure was associated with 2.15-fold greater odds of abnormal LV hemodynamic response (95% CI 1.52–3.05, p<0.001). Further, exercise measures of systemic vascular resistance index, elastance index, and pulse pressure amplification correlated with lower peak VO2. Exercise accentuates elevated arterial stiffness in HFpEF, which in turn correlate with left ventricular hemodynamic responses. Unfavorable ventricular-vascular interactions during exercise in HFpEF may contribute to exertional intolerance and inform future therapeutic interventions. Arterial stiffness and load are accentuated with exercise in heart failure with preserved ejection fraction compared with hypertensive participants and correlate with left ventricular hemodynamic responses to upright incremental exercise. Patients with heart failure exercised on a stationary bicycle while we measured their heart and lung function and their blood pressure. Compared with patients with high blood pressure, patients with heart failure had stiffer blood vessels. Stiffer blood vessels may be related to the shortness of breath and difficulty exercising experienced by patients with heart failure.
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影响因子：
8.3
作者：
McEniery, Carmel M.;McDonnell, Barry;Wilkinson, Ian B.
通讯作者：
Wilkinson, Ian B.
射血分数保留的心力衰竭运动不耐受的机制：异常外周氧提取的作用。
DOI：
10.1161/circheartfailure.114.001825
发表时间：
2015-03
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Dhakal BP;Malhotra R;Murphy RM;Pappagianopoulos PP;Baggish AL;Weiner RB;Houstis NE;Eisman AS;Hough SS;Lewis GD
通讯作者：
Lewis GD
影响因子：
18.2
作者：
Chirinos JA;Londono-Hoyos F;Zamani P;Beraun M;Haines P;Vasim I;Varakantam S;Phan TS;Cappola TP;Margulies KB;Townsend RR;Segers P
通讯作者：
Segers P
影响因子：
8.3
作者：
Kampus, Priit;Serg, Martin;Eha, Jaan
通讯作者：
Eha, Jaan
影响因子：
18.2
作者：
Ikonomidis, Ignatios;Aboyans, Victor;Metra, Marco
通讯作者：
Metra, Marco