Increased left ventricular stiffness impairs exercise capacity in patients with heart failure symptoms despite normal left ventricular ejection fraction.
Increased left ventricular stiffness impairs exercise capacity in patients with heart failure symptoms despite normal left ventricular ejection fraction.
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DOI：
10.4061/2011/692862
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发表时间：
2011-03-02
影响因子：
2.1
通讯作者：
Tschöpe C
中科院分区：
文献类型：
--
作者：
Sinning D;Kasner M;Westermann D;Schulze K;Schultheiss HP;Tschöpe C
目标。尽管左心室射血分数（HFNEF）正常，但心力衰竭患者运动不耐受的发生可能涉及几种机制，可能包括左心室（LV）僵硬度受损。因此，我们研究了左心室僵硬度的影响，通过电导导管法获得的压力-容积环分析，HFNEF的运动能力。方法和结果。27例HFNEF患者在压力-容积（PV）环分析中显示左室舒张功能障碍，进行了限制性心肺运动试验（CPET），并与12例在PV环分析中未显示舒张功能障碍的患者进行了比较。HFNEF患者表现出较低的峰值性能（P = 0.046），呼吸储备（P = 0.006），以及休息时二氧化碳产生的通气当量（P = 0.002）。左心室僵硬度与峰值摄氧量（r =-0.636，P < .001）、舒张阈值时的峰值摄氧量（r =-0.500，P = .009）和舒张阈值时二氧化碳产生的通气当量（r = 0.529，P = .005）相关。结论. CPET参数，如峰值摄氧量、舒张阈值时的峰值摄氧量和舒张阈值时二氧化碳产生的通气当量与LV僵硬度相关。HFNEF患者左心室僵硬度增加会损害运动能力。
Aims. Several mechanisms can be involved in the development of exercise intolerance in patients with heart failure despite normal left ventricular ejection fraction (HFNEF) and may include impairment of left ventricular (LV) stiffness. We therefore investigated the influence of LV stiffness, determined by pressure-volume loop analysis obtained by conductance catheterization, on exercise capacity in HFNEF. Methods and Results. 27 HFNEF patients who showed LV diastolic dysfunction in pressure-volume (PV) loop analysis performed symptom-limited cardiopulmonary exercise testing (CPET) and were compared with 12 patients who did not show diastolic dysfunction in PV loop analysis. HFNEF patients revealed a lower peak performance (P = .046), breathing reserve (P = .006), and ventilation equivalent for carbon dioxide production at rest (P = .002). LV stiffness correlated with peak oxygen uptake (r = −0.636, P < .001), peak oxygen uptake at ventilatory threshold (r = −0.500, P = .009), and ventilation equivalent for carbon dioxide production at ventilatory threshold (r = 0.529, P = .005). Conclusions. CPET parameters such as peak oxygen uptake, peak oxygen uptake at ventilatory threshold, and ventilation equivalent for carbon dioxide production at ventilatory threshold correlate with LV stiffness. Increased LV stiffness impairs exercise capacity in HFNEF.