JAMA：心功能异常与运动能力下降有关

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据1月21日刊JAMA上的一则研究披露，那些左心室舒张功能异常的患者的运动能力会有显著的下降。

已知的与运动能力下降有关的因素有很多，其中包括年龄、女性性别、身体质量指数以及同时存在的其它疾病。找到那些造成最大运动能力下降但又有逆转可能的因素将会有重大的意义。根据文章的背景资讯，某些研究提示，对左心室（四个心脏腔室中的一个）功能的评估可以用来预测某人的运动能力。

Mayo Clinic, Rochester, Minn.的Jasmine Grewal, M.D.及其同僚开展了一项研究，旨在检验左室舒张功能和运动能力之间的关系。该项研究中共包括2867名患者，他们都接受了运动超声心动图（这是一种应用超声波来检查心脏的结构与运动的非创伤性的诊断术），并接受常规的左心室收缩（即心脏的收缩）和舒张功能的测量。研究人员对结果进行了分析以决定哪些因素与运动能力具有最强的相关性以及年龄和性别等变量与运动能力之间有哪些相互作用。

研究人员发现，舒张压功能不良（即舒张受损）与运动能力存在着强烈的反比关系。与正常功能相比，那些在休息状态舒张功能不良的人，其运动能力显著下降。左心室收缩功能在正常范围内的变化与运动能力之间没有联系。

其它的与运动能力有关的独立相关因素有年龄、女性性别以及身体质量指数大于30。与那些具有正常舒张功能的人相比，舒张功能不良的患者会随着年龄的增长而运动能力呈进行性地下降。

文章的作者写道：“在发现舒张功能参数是运动能力的强相关因素的过程中，我们还发现了在运动耐受不良的进展过程中的有可能改变和预防的因素。”（生物谷Bioon.com）

生物谷推荐原始出处：

JAMA. 2009;301(3):286-294.

Left Ventricular Function and Exercise Capacity

Jasmine Grewal, MD; Robert B. McCully, MD; Garvan C. Kane, MD; Carolyn Lam, MD; Patricia A. Pellikka, MD

Context Limited information exists regarding the role of left ventricular function in predicting exercise capacity and impact on age- and sex-related differences.

Objectives To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age.

Design Cross-sectional study of patients undergoing exercise echocardiography with routine measurements of left ventricular systolic and diastolic function by 2-dimensional and Doppler techniques. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity.

Setting Large tertiary referral center in Rochester, Minnesota, in 2006.

Participants Patients undergoing exercise echocardiography using the Bruce protocol (N = 2867). Patients with echocardiographic evidence of exercise-induced ischemia, ejection fractions lower than 50%, or significant valvular heart disease were excluded.

Main Outcome Measure Exercise capacity in metabolic equivalents (METs).

Results Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, after multivariate adjustment, those with moderate/severe resting diastolic dysfunction (–1.30 METs; 95% confidence interval [CI], –1.52 to –0.99; P < .001) and mild resting diastolic dysfunction (–0.70 METs; 95% CI, –0.88 to –0.46; P < .001) had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity. Left ventricular filling pressures measured by resting E/e' of 15 or greater (–0.41 METs; 95% CI, –0.70 to –0.11; P = .007) or postexercise E/e' of 15 or greater (–0.41 METs; 95% CI, –0.71 to –0.11; P = .007) were similarly associated with a reduction in exercise capacity, each in separate multivariate analyses. Individuals with impaired relaxation (mild dysfunction) or resting E/e' of 15 or greater had a progressive increase in the magnitude of reduction in exercise capacity with advancing age (P < .001 and P = .02, respectively). Other independent correlates of exercise capacity were age (unstandardized β coefficient, –0.85 METs; 95% CI, –0.92 to –0.77, per 10-year increment; P < .001), female sex (–1.98 METs; 95% CI, –2.15 to –1.84; P < .001), and body mass index greater than 30 (–1.24 METs; 95% CI, –1.41 to –1.10; P < .001).

Conclusion In this large cross-sectional study of those referred for exercise echocardiography and not limited by ischemia, abnormalities of left ventricular diastolic function were independently associated with exercise capacity.

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