Resting ventricular-vascular function and exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study.
Resting ventricular-vascular function and exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study.
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DOI：
10.1161/circheartfailure.114.001192
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发表时间：
2014-07
期刊：
影响因子：
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通讯作者：
Redfield MM
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文献类型：
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作者：
Mohammed SF;Borlaug BA;McNulty S;Lewis GD;Lin G;Zakeri R;Semigran MJ;LeWinter M;Hernandez AF;Braunwald E;Redfield MM
运动不耐受是心力衰竭（HF）的标志，但与心力衰竭伴EF保存（HFpEF）患者运动能力受损相关的因素尚不清楚。我们假设在HFpEF中，静息心室和血管功能障碍的严重程度与通过峰值耗氧量（pVO2）评估的运动耐量损害有关。参加“抑制磷酸二酯酶-5改善舒张性心力衰竭临床状态和运动能力”（RELAX）临床试验（n=216）的HFpEF患者接受了基线多普勒超声心动图、心肺运动试验和心脏磁共振成像。RELAX参与者为老年人（中位年龄69岁），48%为女性。EF（60%）和卒中容积（77 ml）正常，而舒张功能障碍（内侧E/ E ' 16，减速时间185 msec，左房容积44 ml/m2）和动脉负荷增加（动脉弹性（Ea） 1.51 mmHg/ml）明显。PVO2降低（11.7 ml/kg/min, 1141 ml/min），年龄、性别、体重指数（BMI）、血红蛋白和变时反应共同解释了原始PVO2 （ml/min）变化的64%。在对这些变量进行调整后，左室结构（舒张尺寸（1.5%,p=0.008）和左室质量（1.6%,p=0.008））、静息卒中容积（2.0%,p=0.002）、左室舒张功能障碍(减速时间（0.9%,p=0.03）和E/ E ' （1.4%, p=0.009）、动脉功能（Ea （2.1%, p=0.002）和全身动脉顺应性（1.5%,p=0.007））仅解释了pVO2方差的一小部分。在HFpEF中，潜在的可改变因素（肥胖、贫血和变时功能不全）与运动能力密切相关，而静息时心室和血管结构和功能的测量则无关。；URL: http://www.clinicaltrials.gov。唯一标识符：NCT00763867。
Exercise intolerance is a hallmark of heart failure (HF), but factors associated with impaired exercise capacity in HF with preserved EF (HFpEF) are unclear. We hypothesized that in HFpEF, the severity of resting ventricular and vascular dysfunction are associated with impairment in exercise tolerance as assessed by peak oxygen consumption (pVO2). Subjects with HFpEF enrolled in the PhosphodiesteRasE-5 Inhibition to Improve CLinical Status And EXercise Capacity in Diastolic Heart Failure (RELAX) clinical trial (n=216) underwent baseline Doppler echocardiography, cardiopulmonary exercise testing and cardiac magnetic resonance imaging. RELAX participants were elderly (median age 69 years) and 48% were women. EF (60%) and stroke volume (77 ml) were normal, while diastolic dysfunction (medial E/e′ 16, deceleration time 185 msec, left atrial volume 44 ml/m2) and increased arterial load (arterial elastance (Ea) 1.51 mmHg/ml) were evident. PVO2 was reduced (11.7 ml/kg/min, 1141 ml/min) and age, sex, body mass index (BMI), hemoglobin and chronotropic response collectively explained 64% of the variance in raw pVO2 (ml/min). After adjustment for these variables, LV structure (diastolic dimension (1.5%, p=0.008) and LV mass (1.6%, p=0.008)), resting stroke volume (2.0%, p=0.002), LV diastolic dysfunction (deceleration time (0.9%, p=0.03) and E/e′ (1.4%, p=0.009), and arterial function (Ea (2.1%, p=0.002) and systemic arterial compliance (1.5%, p=0.007)), each explained only a small additional portion of the variance in pVO2. In HFpEF, potentially modifiable factors (obesity, anemia and chronotropic incompetence) are strongly associated with exercise capacity whereas resting measures of ventricular and vascular structure and function are not. ;URL: http://www.clinicaltrials.gov. Unique identifier: NCT00763867.