EXERCISE TRAINING/DIASTOLIC HEART FAILURE IN THE ELDERLY

老年人的运动训练/舒张性心力衰竭

• 批准号: 2732550
• 负责人: DALANE W KITZMAN
• 金额: $ 28.56万
• 依托单位: WAKE FOREST UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-01 至 2001-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2732550
• 关键词: aerobic exercise; age difference; clinical research; clinical trials; congestive heart failure; echocardiography; gender difference; human old age (65+); human subject; human therapy evaluation; nitric oxide; oxygen consumption; therapy; ultrasound blood flow measurement; vasodilation

Diastolic heart failure accounts for over 50% of heart failure cases in the population greater than 65 and is an important health care problem for older Americans. Our current research shows that elderly patients with diastolic heart failure have severe exercise intolerance and that this improves with exercise training. However, less than 30% of the improvement is attributable to increased cardiac output. This suggests a potential role for impaired peripheral vasoregulation by compromising muscle perfusion. Our pilot data suggest that in elderly diastolic heart failure patients endothelial dependent flow mediated arterial dilation (FMAD) is substantially impaired, correlates with exercise capacity, and is increased after exercise training. The primary aims of this study are to perform an initial cross-sectional comparison of 60 elderly diastolic heart failure patients (symptomatic heart failure, a normal LV ejection fraction and no significant coronary or valvular heart disease or pulmonary disease) with matched healthy normal subjects and then to enter the patients into a randomized, controlled, single blinded trial of aerobic exercise training in order to test the following specific hypotheses: 1. Elderly diastolic heart failure patients have decreased FMAD compared to age and gender matched healthy normal subjects. 2. Exercise intolerance in elderly diastolic heart failure patients is associated with decreased FMAD. 3. Exercise training in elderly heart failure patients will improve FMAD and exercise capacity. 4. Improvements in exercise capacity will correlate with improvements in FMAD. A secondary aim is to examine relationship between FMAD and other determinants of ventricular-vascular coupling. Principle measurements include brachial artery FMAD and indexes of carotid artery stiffness by high resolution ultrasound; pulse wave velocity by tonometry; maximal and submaximal oxygen consumption and ventilatory anerobic threshold by expired gas analysis, and cardiac volumes by digital echocardiography. This study will assess the contribution of endothelial dysfunction to exercise intolerance in diastolic heart failure using a physiologically rational, widely applicable intervention.

舒张性心力衰竭占心力衰竭病例的 50% 以上 在 65 岁以上的人口中，是重要的医疗保健 美国老年人的问题。 我们目前的研究表明 老年舒张性心力衰竭患者剧烈运动 不耐受，并且通过运动训练可以改善这种情况。 然而， 不到 30% 的改进归因于增加 心输出量。 这表明受损的潜在作用 通过损害肌肉灌注来调节外周血管。 我们的 试点数据表明，老年舒张性心力衰竭患者 内皮依赖性血流介导的动脉扩张（FMAD） 严重受损，与运动能力相关，并且 运动训练后增加。 本研究的主要目的 对 60 名老年人进行初步横断面比较 舒张性心力衰竭患者（有症状的心力衰竭，正常 左心室射血分数且无明显冠状动脉或瓣膜病 疾病或肺部疾病）与匹配的健康正常受试者 然后将患者纳入随机、受控、单一的研究中 有氧运动训练的盲法试验，以测试 具体假设如下： 1. 老年舒张性心力衰竭 与年龄和性别相比，患者的 FMAD 降低 匹配健康正常受试者。 2. 运动不耐受 老年舒张性心力衰竭患者的心力下降与 FMAD。 3.老年心力衰竭患者的运动训练 提高FMAD和运动能力。 4. 改进 运动能力与 FMAD 的改善相关。 一个 次要目的是研究 FMAD 与其他因素之间的关系 心室-血管耦合的决定因素。 原则 测量包括肱动脉 FMAD 和颈动脉指数 高分辨率超声检测动脉僵硬度；脉搏波速度 通过眼压测量；最大和次最大耗氧量以及 通过呼出气体分析确定通气无氧阈值，以及心脏 通过数字超声心动图测量体积。 这项研究将评估 内皮功能障碍对运动不耐受的影响 舒张性心力衰竭使用生理上合理的、广泛的 适用的干预措施。