呼吸模式和肺气交换在老年患者和没有左心室功能障碍修改与基于炼的心脏康复和预后价值的老年患者
Prisca Eser1, Thimo Marcin1, Eva Prescott2
1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Frontiers in cardiovascular medicine
|September 20, 2023
概括
低效的通风在患有左心室功能障碍 (LVD) 的老年患者中很常见,并预测不良心血管事件. 基于运动的心脏康复 (exCR) 改善了这些患者的呼吸模式和气体交换.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 运动生理学 运动生理学
背景情况:
- 低效的通风是心力衰竭患者已知的预后不良标志物.
- 在患有左心室功能障碍 (LVD) 但没有明显心力衰竭的患者中,低效通风和预后之间的联系尚不清楚.
研究的目的:
- 为了确定不高效的通风是否比没有LVD的老年患者更普遍.
- 评估基于运动的心脏康复 (exCR) 是否能改善LVD患者的通风.
- 在这个人群中调查低效通风和主要心血管不良事件 (MACE) 之间的关联.
主要方法:
- 一项大型,多中心的长度观察研究包括818名冠状动脉综合征的老年患者 (≥65岁).
- 心肺运动测试 (CPET) 在基线,后EXCR和12个月的随访中测量了呼吸系统参数 (VE,BF,VT,PETCO2).
- 通过心声声谱对患有或没有LVD的患者进行了分类,结果与12个月后的MACE相关.
主要成果:
- 18%的患者患有LVD. 与没有LVD患者相比,LVD患者的休息通风和呼吸频率增加,峰值潮体积和末尾呼气二氧化碳压力降低.
- exCR导致静止通风和峰值PETCO2的显著改善,在LVD患者中更为明显.
- 在LVD患者中,更高的静止呼吸频率,更高的最低VE/VCO2斜率,以及基线较低的峰值PETCO2与MACE相关.
结论:
- 患有缺血性LVD的老年患者显示休息和运动通风效率低下,与更糟糕的结果相关.
- exCR在缓解异常呼吸模式和改善LVD患者的气体交换参数方面表现出有效性.
- 在LVD患者中,低效的通风作为预后指标,类似于其在心力衰竭中的作用.
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