高強度間歇運動促進心臟衰竭病患之心肺適能與左心室重塑相關

Reversal of Left Ventricular Remodeling Associated with High-Intensity Interval Training Promoting Cardiorespiratory Fitness in Heart Failure Patients

朱憲德(Hsien-Te Chu) ； 傅鐵城(Tieh-Cheng Fu) ； 王鐘賢(Jong-Shyan Wang) ； 許智欽(Chih-Chin Hsu)

《台灣復健醫學雜誌》 49卷2期 (2021/12) Pp. 147-157

https://doi.org/10.6315/TJPMR.202112_49(2).0002

摘要

本研究旨在探討心臟衰竭（heart failure）病患在接受高強度間歇運動訓練（high-intensity intervil training）前後，心肺適能（cardiorespiratory fitness）與左心室重塑（left ventricular remodeling）的變化，以及兩者間的相關性。我們針對2009 年至2018年間接受本院心臟衰竭照護的患者中，選出其中17位心臟衰竭病患，按照病患偏好（preference），分為接受醫院內監測運動訓練，以及居家照護（非運動）兩組。我們針對這兩群病患進行運動前心血管磁振造影（cardiovascular magnetic resonance imaging）檢查及心肺運動功能測試（cardiopulmonary exercise test）。在完成上述評估後，運動組除繼續服用現行藥物外，還進行每星期2-3次的交替80%及40%峰值耗氧量（oxygen consumption）運動訓練共36次。非運動組（對照組）則以藥物治療為主。運動組在完成運動訓練後，對照組在開始納入觀察3-4個月後，再進行追蹤一次心血管磁振造影與心肺運動功能測試。我們發現高強度間歇運動訓練有意義地增加心臟衰竭病患左心室射出率、降低左心室收縮末期體積、減少左心室心肌質量、及減輕心臟壓力。峰值心輸出量與耗氧量在運動訓練後的進步，也伴隨著以上這些心臟功能與幾何學的變化而發生。然而從對照組病患的心血管磁振造影檢查與心肺運動功能測試結果觀察不到上述變化。我們同時發現兩組間運動前後左心室心肌質量變化程度，與峰值耗氧量的變化程度是有意義的差別。至於峰值耗氧量的進步幅度則與左心室心肌質量的降低，左心室收縮末期體積的減少，以及運動中的峰值心輸出量相關。因此我們推論，針對心臟衰竭的病患而言，高強度間歇運動訓練可以透過逆轉左心室重塑作用改善幫助心臟衰竭病患之心肺適能。

關鍵字

有氧運動（aerobic exercise） ； 心臟衰竭（heart failure） ； 耗氧量（oxygen consumption） ； 左心室重塑（left ventricular remodeling）

並列摘要

This study was designed to explore the high-intensity interval training (HIIT) effects on cardiorespiratory fitness as well as the reversal of left ventricle (LV) remodeling, and association between them in heart failure (HF) patients. We included HF patients under our HF care program between 2009 and 2018. The 17 HF patients enrolled in the study were further divided into in-hospital supervised HIIT (n=8) or medical care (control) (n=9) groups according to their preference. All participants underwent cardiovascular magnetic resonance imaging (CMR) examination and a cardiopulmonary exercise test (CPET) before the exercise intervention or medical care. The HIIT participants had 36 sessions of HIIT, 2 to 3 sessions every week for 3 to 4 months, along with their current medical treatment. The HIIT involved alternating 80% and 40% peak oxygen consumption(VO_(2peak)) exercise intensity for 30 min in each session. Only medical treatment was prescribed for the control group. After completing HIIT training (i.e., 3-4 months after initial recruitment), all participants underwent CMR and CPET. HIIT significantly improved in LV ejection fraction and reduced LV end-systolic volume (LVESV) as well as LV mass (LVM), accompanied by increased cardiorespiratory fitness and cardiac output during exercise. However, these significant alterations were not observed in the control group. HIIT participants showed significantly greater reduced LVM and improved VO_(2peak) than controls. The improvement in VO_(2peak) was significantly correlated with reduced LVESV and LVM as well as increased cardiac output during exercise. Promotion of HIIT in cardiorespiratory fitness in HF patients may be associated with the reversal of LV remodeling.

並列關鍵字

aerobic exercise ； heart failure ； oxygen consumption ； left ventricular remodeling

參考文獻

Roth GA, Huffman MD, Moran AE, Feigin V, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation 2015;132:1667-78.

Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016;37:2129-2200.

Cook C, Cole G, Asaria P, et al. The annual global economic burden of heart failure. Int J Cardiol 2014;171:368-76.

Mann DL and Bristow MR. Mechanisms and models in heart failure: the biomechanical model and beyond. Circulation 2005;111:2837-49.

Sutton MGSJ and Sharpe N. Left Ventricular Remodeling After Myocardial Infarction: Pathophysiology and Therapy. Circulation 2000;101:2981-88.