Prevalence and management of chronotropic incompetence in heart failure.
Prevalence and management of chronotropic incompetence in heart failure.
复制标题
心力衰竭变时性功能不全的患病率和治疗。
DOI：
10.1007/bf02938355
复制
发表时间：
2007
影响因子：
3.7
通讯作者：
Kitzman,DalaneW
中科院分区：
文献类型：
--
作者：
Brubaker,PeterH;Kitzman,DalaneW
尽管变时性功能不全(CL)在无症状和冠状动脉疾病人群中具有重要的预后价值，但对于CL在心力衰竭中的患病率和影响却很少受到关注。在心力衰竭文献中报道的变时性损害的患病率(25%-70%)有相当大的变异性，可能是由于缺乏标准化的定义和/或不同的评估方法。虽然氯的确切患病率尚有争议，涉及的确切病理生理机制仍不确定，但明确的证据表明，变时性损害显著地导致了无数已知的心血管、神经肌肉、肺和神经激素适应不良，这些不良反应对大多数心力衰竭患者的身体功能和生活质量产生了负面影响。具体地说，对运动不适当的变时性反应可能会使峰值运动摄氧量降低15%至20%。改善变时性功能的治疗干预措施，包括耐力运动训练和频率适应性起搏，尽管前景看好，但仍值得进一步研究。
Although chronotropic incompetence (Cl) has been shown to have important prognostic value in asymptomatic and coronary artery disease populations, much less attention has been given to the prevalence and impact of Cl in heart failure. There is considerable variability in the reported prevalence of chronotropic impairment (25%–70%) in the heart failure literature, likely due to a lack of a standardized definition and/or differing assessment methodologies. Although the exact prevalence of Cl is debatable and the precise pathophysiologic mechanisms involved remain uncertain, there is unambiguous evidence indicating that chronotropic impairment contributes significantly to the myriad of cardiovascular, neuromuscular, pulmonary, and neurohormonal maladaptations known to negatively impact the physical functional and quality of life of most heart failure patients. Specifically, an inappropriate chronotropic response to exercise can decrease peak exercise oxygen uptake by as much as 15% to 20%. Therapeutic interventions to improve chronotropic function, including endurance exercise training and rate-adaptive pacing, although promising, still warrant further investigation.