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首页> 外文期刊>Annals of physical and rehabilitation medicine >Functional outcome in chronic heart failure after exercise training: Possible predictive value of heart rate variability
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Functional outcome in chronic heart failure after exercise training: Possible predictive value of heart rate variability

机译：运动训练后慢性心力衰竭的功能结果：心率变异性的可能预测价值

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Background: Controlled exercise training (ET) is a valuable therapeutic addition to pharmacological treatment in most patients with chronic heart failure (CHF), reducing long-term mortality, preventing cardiac remodelling and improving functional capacity. Despite the fact that the mechanism underlying its benefits might be multifactorial, a sustained improvement in autonomic balance is usually attributed as a major effect. Nevertheless, not all eligible subjects show the same response to ET, probably due to several differences in the subpopulations enrolled. We hypothesize that some heart rate variability (HRV) indexes could be valid tools to optimize the selection and follow-up of CHF patients receiving ET intervention. Methods: Forty patients with CHF and left ventricular ejection fraction (LVEF) < =40 under complete evidence-based pharmacological treatment were included; 20 were assigned to a program of controlled ET on a 3-times/week basis during 24 weeks, training group (TG) and 20 received a standard follow-up program, control group (CG). In each patient, full clinical assessments, echocardiography, HRV analysis and 6-minute-walk test were performed at the beginning and the end of the study. Results: After 24 weeks, patients in the TG showed a significant improvement in LVEF, 6-minute walk test, functional class of symptoms and HRV parasympathetic related indices (HF and rMSSD). Patients in the CG did not exhibit any improvement in the aforementioned indices and experienced more adverse events. Moreover, an initial value of HF < 150 ms~2/Hz or rMSSD < 20 ms predicted better outcomes of the ET program, including improvements in systolic function, the distance walked in 6 minutes, and the functional class of symptoms, along with a reduction in clinical events. Conclusions: In CHF patients, HRV indexes related to parasympathetic function are valid and clinically useful tools to select and follow-up those candidates that could experience superior functional improvement after ET.
机译：背景：控制运动训练 （ET） 是大多数慢性心力衰竭 （CHF） 患者药物治疗的宝贵治疗补充，可降低长期死亡率、预防心脏重塑并改善功能能力。尽管其益处背后的机制可能是多因素的，但自主神经平衡的持续改善通常被认为是一个主要影响。然而，并非所有符合条件的受试者都对 ET 表现出相同的反应，这可能是由于入组亚群的几个差异。我们假设一些心率变异性 （HRV） 指数可能是优化接受 ET 干预的 CHF 患者的选择和随访的有效工具。方法：纳入40例CHF患者，LVEF<=40%接受完全循证药物治疗;20 名受试者在 24 周内每周 3 次接受对照 ET 计划，培训组 （TG） 和 20 名接受标准随访计划，即对照组 （CG）。在每位患者中，在研究开始和结束时进行了全面的临床评估、超声心动图、HRV 分析和 6 分钟步行测试。结果：24周后，TG患者LVEF、6分钟步行试验、症状功能类别和HRV副交感神经相关指标（HF和rMSSD）均有显著改善。CG中的患者在上述指标上没有表现出任何改善，并且经历了更多的不良事件。此外，HF < 150 ms~2/Hz 或 rMSSD < 20 ms 的初始值预测了 ET 计划的更好结果，包括收缩功能的改善、6 分钟内的步行距离和症状的功能类别，以及临床事件的减少。结论：在充血性心力衰竭患者中，与副交感神经功能相关的HRV指标是有效且临床有用的工具，可用于选择和随访那些在ET后可能获得卓越功能改善的候选者。

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