心力衰竭患者心肺运动试验特征的探讨

Characteristics of cardiopulmonary exercise test in heart failure patients:apropensity-matched analysis

目的:探讨不同射血分数心力衰竭患者心肺运动试验特征。方法:回顾性收集2007年3月~2019年7月在同济大学附属同济医院心脏康复中心行心肺运动试验检查的438例心力衰竭患者为研究对象,比较不同射血分数心力衰竭患者心肺运动试验特征,其中153例射血分数减少型心力衰竭(HFrEF),115例射血分数中间型心力衰竭(HFmrEF)和170例射血分数保留型心力衰竭(HFpEF)。结果:由于3组基线数据部分有统计学差异(HFpEF组年龄、女性比例较另2组高,均P<0.05),故亚组间进行倾向性评分匹配后进行比较,结果显示亚组间峰值循环动力(CPpeak)、峰值氧脉搏(peak VO2/HR)、峰值负荷功率(Load peak)、二氧化碳通气当量斜率(VE/VCO2slope)有明显统计学差异(均P<0.001),峰值耗氧量(VO2peak)、无氧阈负荷功率(Load AT)有统计学差异(均P<0.05)。结论:不同射血分数心衰患者的运动耐力、肺通气效率、峰值循环动力有差异,可能对不同表型心衰之间的关系有一定的提示意义。

Objective:To explore the characteristics of cardiopulmonary exercise test in heart failure patients with different ejection fractions.Methods:A total of 438 patients with heart failure who underwent cardiopulmonary exercise test in Tongji Hospital Heart Rehabilitation Center Affiliated to Tongji University from March 2007 to July2019 were collected retrospectively,and the characteristics of cardiopulmonary exercise test in heart failure patients with different ejection fractions were compared,including 153 patients with heart failure with reduced ejection fraction(HFrEF),115 patients with heart failure with mid-range ejection fraction(HFmrEF)and 170 patients with heart failure with preserved ejection fraction(HFpEF).Results:Because there were statistically significant differences in some baseline data among the three groups(the age was older and female ratio was higher in HFpEF group than those in the rest two groups,(all P<0.05),the comparison between the subgroups was made after matching the propensity score.The results showed that there were significant differences in peak circulatory power(CPpeak),peak oxygen pulse(peak VO_(2)/HR),load peak,the slope of minute ventilation versus carbon dioxide production(VE/VCO_(2) slope)(all P<0.01),peak oxygen consumption(VO_(2) peak)and load power at anaerobic threshold(load AT)(all P<0.05).Conclusions:There are significant differences in exercise endurance,pulmonary ventilation efficiency and peak circulatory power among heart failure patients with different ejection fractions,which may have some implications for the relationship between different phenotypes of heart failure.