Claire Maufrais, Matthieu Josse, Laure Patrier, Antoine Grandperrin, Myriam Isnard, Cécile Turc-Baron, Stéphane Nottin, Stéphane Mandigout, Jean-Paul Cristol, Philippe Obert
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In this prospective, open-label, two-center randomized crossover trial, 56 stable individuals receiving HD participated in 2 HD sessions in random order: standard HD and a session incorporating 30 min of aerobic exercise. LA and LV global longitudinal strains (GLSs) were obtained before and at peak stress of HD (i.e., 30 min before the HD ending). IDE totally eradicated the decline in LA reservoir strain observed during HD (estimated difference: 3.1%, 95% confidence interval: 0.4/5.8, <i>P</i> = 0.02), whereas it did not affect the other components of LA mechanics. A similar result favoring IDE intervention was also demonstrated on GLS changes over the HD procedure (<i>P</i> < 0.001). Between-session differences of changes in GLS and LA reservoir strain were correlated (<i>r</i> = -0.32, <i>P</i> = 0.03). The cardioprotective effect of IDE disappeared in patients with LA enlargement (i.e., LA volume index >34 mL/m<sup>2</sup>). In conclusion, even a short duration of IDE at moderate intensity is effective in preventing HD-associated decline in LA reservoir function. Further research is needed to explore the long-term benefits of IDE on LA function.<b>NEW & NOTEWORTHY</b> A single bout of intradialytic exercise (IDE) at moderate intensity can prevent the hemodialysis-associated decline in left atrial (LA) function. This was partially explained by the relative preservation of left ventricular systolic function with IDE. Benefits of IDE on LA function were lost in patients with LA dilation. Further studies are needed to explore the mechanisms behind IDE-induced cardioprotection and evaluate the clinical impacts of the repetitive cardioprotective effects of IDE on LA function.</p>","PeriodicalId":93867,"journal":{"name":"American journal of physiology. 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There is growing evidence of the cardioprotective effect of intradialytic exercise (IDE) on LV function, but studies analyzing its effect on LA function are scarce. Our aim was to evaluate whether IDE can limit the severity of HD-induced impairment in LA myocardial function. In this prospective, open-label, two-center randomized crossover trial, 56 stable individuals receiving HD participated in 2 HD sessions in random order: standard HD and a session incorporating 30 min of aerobic exercise. LA and LV global longitudinal strains (GLSs) were obtained before and at peak stress of HD (i.e., 30 min before the HD ending). IDE totally eradicated the decline in LA reservoir strain observed during HD (estimated difference: 3.1%, 95% confidence interval: 0.4/5.8, <i>P</i> = 0.02), whereas it did not affect the other components of LA mechanics. A similar result favoring IDE intervention was also demonstrated on GLS changes over the HD procedure (<i>P</i> < 0.001). Between-session differences of changes in GLS and LA reservoir strain were correlated (<i>r</i> = -0.32, <i>P</i> = 0.03). The cardioprotective effect of IDE disappeared in patients with LA enlargement (i.e., LA volume index >34 mL/m<sup>2</sup>). In conclusion, even a short duration of IDE at moderate intensity is effective in preventing HD-associated decline in LA reservoir function. Further research is needed to explore the long-term benefits of IDE on LA function.<b>NEW & NOTEWORTHY</b> A single bout of intradialytic exercise (IDE) at moderate intensity can prevent the hemodialysis-associated decline in left atrial (LA) function. This was partially explained by the relative preservation of left ventricular systolic function with IDE. Benefits of IDE on LA function were lost in patients with LA dilation. 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引用次数: 0
摘要
导言:左心房(LA)功能通过调节左心室(LV)功能在心脏性能中起着关键作用。血液透析期间左心室功能受损的报道屡见不鲜,但描述左心房功能变化的现有数据却十分有限。越来越多的证据表明,血液透析内运动(IDE)对左心室功能有保护作用,但分析其对 LA 功能影响的研究却很少。我们的目的是评估 IDE 是否能限制血液透析引起的 LA 心肌功能损害的严重程度:在这项前瞻性、开放标签、双中心随机交叉试验中,56 名稳定的血液透析患者按照随机顺序参加了两次血液透析:标准血液透析(HD)和一次 30 分钟的有氧运动。在血液透析前和血液透析高峰压力时(即血液透析结束前30分钟)采集LA和LV整体纵向(GLS)应变:IDE完全消除了HD期间观察到的LA储层应变的下降(估计差异:3.1%,95% CI 0.4/5.8,P=0.02),而对LA力学的其他组成部分没有影响。在 HD 过程中,GLS 的变化(p34 mL/m²)也显示了类似的有利于 IDE 干预的结果:结论:即使是中等强度的短期 IDE 也能有效防止血液透析引起的 LA 储库功能下降。需要进一步研究 IDE 对 LA 功能的长期益处。
Cardioprotective effect of intradialytic exercise on left atrial mechanics.
Left atrial (LA) function plays a pivotal role in cardiac performance by modulating left ventricular (LV) function. Impairments in LV function are commonly reported during hemodialysis (HD), but available data describing changes in LA function are limited. There is growing evidence of the cardioprotective effect of intradialytic exercise (IDE) on LV function, but studies analyzing its effect on LA function are scarce. Our aim was to evaluate whether IDE can limit the severity of HD-induced impairment in LA myocardial function. In this prospective, open-label, two-center randomized crossover trial, 56 stable individuals receiving HD participated in 2 HD sessions in random order: standard HD and a session incorporating 30 min of aerobic exercise. LA and LV global longitudinal strains (GLSs) were obtained before and at peak stress of HD (i.e., 30 min before the HD ending). IDE totally eradicated the decline in LA reservoir strain observed during HD (estimated difference: 3.1%, 95% confidence interval: 0.4/5.8, P = 0.02), whereas it did not affect the other components of LA mechanics. A similar result favoring IDE intervention was also demonstrated on GLS changes over the HD procedure (P < 0.001). Between-session differences of changes in GLS and LA reservoir strain were correlated (r = -0.32, P = 0.03). The cardioprotective effect of IDE disappeared in patients with LA enlargement (i.e., LA volume index >34 mL/m2). In conclusion, even a short duration of IDE at moderate intensity is effective in preventing HD-associated decline in LA reservoir function. Further research is needed to explore the long-term benefits of IDE on LA function.NEW & NOTEWORTHY A single bout of intradialytic exercise (IDE) at moderate intensity can prevent the hemodialysis-associated decline in left atrial (LA) function. This was partially explained by the relative preservation of left ventricular systolic function with IDE. Benefits of IDE on LA function were lost in patients with LA dilation. Further studies are needed to explore the mechanisms behind IDE-induced cardioprotection and evaluate the clinical impacts of the repetitive cardioprotective effects of IDE on LA function.