患有心力衰竭和保存的喷射分数的患者中亚最大运动不耐受性的决定因素:从乳酸值的洞察力
Shunichi Doi1, Atsushi Tada1, Tomonari Harada1
1Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA.
European journal of heart failure
|June 18, 2025
概括
三分之二的心力衰竭与保存的喷射分数患者有下最大适应能力受损,通常与女性性别,贫血和肺血管疾病有关. 评估亚最大运动能力对于了解HFpEF患者的局限性至关重要.
科学领域:
- 心脏病学 心脏病学
- 运动生理学 运动生理学
背景情况:
- 运动氧气消耗的峰值是评估心力衰竭与保留射出小部分 (HFpEF) 功能障碍的标准.
- 然而,大多数HFpEF患者在日常生活中没有达到峰值强度的运动,因此需要替代的子最大适应度指标.
- 在HFpEF中,亚最大运动不耐症的病理生理学仍未得到充分探索.
研究的目的:
- 研究HFpEF患者的亚最大运动不耐受症的特征和影响.
- 为以患者为中心的评估,探索超出峰值运动能力的替代指标.
主要方法:
- 用乳酸测量进行的侵入性心肺运动测试对286名HFpEF患者进行.
- 乳酸值 (LT) 被定义为动脉乳酸超过2.0mmol/L的工作负载,作为亚最大适应性的衡量标准.
- 通过使用非侵入性通风门测量来证实这些发现.
主要成果:
- 68%的HFpEF患者 (n=194) 达到40W或以下的LT (LT ≤40W).
- 与LT>40W (p <0.01) 患者相比,LT ≤40W的患者更有可能是女性,贫血,并患有较大的肺血管疾病 (p <0.01).
- 在低水平运动 (20W) 期间,LT ≤ 40W 患者表现出更高的肺动脉压力,双心室填充压力,通风,呼吸障碍和疲劳,与更大的A-V氧气差异,尽管心脏输出量相似.
结论:
- 显著的大多数HFpEF患者在日常生活活动水平上表现出下最大适应能力受损.
- 在HFpEF中减弱的亚最大适应性与特定的人口和临床因素有关,包括女性性别,贫血和肺血管疾病.
- 低水平运动期间血液动力学,症状和通风的异常是HFpEF下最大适应能力受损的特征,这凸显了评估治疗影响的最大有氧能力和峰值有氧能力的重要性.
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