Hemodynamic Effects of Exercise Training in Heart Failure
Hemodynamic Effects of Exercise Training in Heart Failure
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DOI：
10.1016/j.cardfail.2011.07.010
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发表时间：
2011-11-01
影响因子：
6
通讯作者：
Agostoni, Piergiuseppe
中科院分区：
文献类型：
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作者：
Cattadori, Gaia;Schmid, Jean-Paul;Agostoni, Piergiuseppe
背景：心力衰竭(HF)患者训练后运动能力的改善可能是由于中枢或外周的改变。方法和结果：我们测量了70名心力衰竭稳定患者训练前后的峰值VO2和心输出量(CO，惰性气体重复呼吸法)，并计算了动静脉氧分压差(a-vO(2)diff)。VO2峰值从1111+/-403mL/min变化到1191+/-441(P<；.0001)，峰值工作负荷从68+/-29W/min变化到76+/-32(P<；0.0001)，峰值CO从6.6+/-2.2 L/分钟变化到7.3+/-2.5(P<；0.0001)，a-vO(2)峰值从17.5+/-5.1mL/100mL变化到16.6+/-4.1(P=.081)。CO峰值和a-VO(2)diff的变化可区分4种行为：第1组：(n=15)峰值CO减少，a-vO(2)diff增加(峰值VO2不变，峰值负荷+9.5%)，第2组：(n=16)峰值CO和a-vO(2)diff增加，峰值VO2(23%)和负荷(18%)增加；第3组：(n=4)峰值CO和a-VO(2)diff降低，峰值VO2(-18%)和工作负荷(-5%)降低；第4组(n=35)峰值CO增加，a-vO(2)diff降低(峰值VO2增加5.5，工作负荷增加8.4%)。结论：运动训练通过增加CO而改善峰值VO(2)，a-vO(2)diff不变。训练后a-v O(2)diff的减少和CO的增加是常见的(50%的病例)，提示血流重新分配，本身并不是肌肉性能下降的迹象与运动能力的提高有关。(J心力衰竭2011；17：916-922)
Background: Exercise performance improvement after training in heart failure (HF) can be due to central or peripheral changes.Methods and Results: In 70 HF stable patients we measured peak VO2 and cardiac output (CO, inert gas rebreathing technique) and calculated arteriovenous O-2 differences (a-v O(2)diff) before and after an 8-week training program. Peak VO2 changed from 1111 +/- 403 mL/minute to 1191 +/- 441 (P < .001), peak workload from 68 +/- 29 watts to 76 +/- 32 (P < .0001), peakCO from 6.6 +/- 2.2 L/minute to 7.3 +/- 2.5 (P < .0001), and peak a-v O(2)diff from 17.5 +/- 5.1 mL/100 mL to 16.6 +/- 4.1 (P = .081). Changes in peak CO and a-v O(2)diff allowed to identify 4 behaviors: group 1: (n = 15) reduction in peak CO and increase in a-v O(2)diff (peak VO2 unchanged, peak workload +9.5%); group 2: (n = 16) both peak CO and a-v O(2)diff increased as well as peak VO2 (23%) and workload (18%); group 3: (n = 4) peak CO and a-v O(2)diff reduced as well as peak VO2 (-18%) and workload (-5%); group 4: (n = 35) peak CO increased with a-v O(2)diff reduced (increase in peak VO2 by 5.5 and workload by 8.4%).Conclusions: Exercise training improves peakVO(2) by increasing CO with unchanged a-v O(2)diff. A reduction after training of a-v O(2)diff with an increase in CO is frequent (50% of cases), is suggestive of blood flow redistribution and, per se, not a sign of reduced muscle performance been associated with improved exercise capacity. (J Cardiac Fail 2011;17:916-922)