Ahmad Mroué, Stéphane Roueff, Isabella Vanorio-Vega, Hélène Lazareth, Oksana Kovalska, Adrien Flahault, Philippe Tuppin, Eric Thervet, Marie-Christine Iliou
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Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ).</p><p><strong>Results: </strong>Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results.</p><p><strong>Conclusions: </strong>Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. 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引用次数: 0
摘要
目的:慢性肾脏疾病(CKD)常见于心力衰竭(HF)。慢性肾脏疾病通常会恶化HF患者的预后并损害其管理。慢性肾脏疾病经常伴有少肌症,这限制了心脏康复(CR)的益处。本研究的目的是根据CKD分期评估CR对射血分数降低(HFrEF)的HF患者心肺健康的影响。方法:我们进行了一项回顾性研究,包括567名连续的HFrEF患者,他们接受了4 k CR计划,并在计划前后通过心肺运动测试进行了评估。根据估计的肾小球滤过率(eGFR)对患者进行分层。我们进行了多变量分析,寻找与峰值摄氧量提高10%(V*O2峰值)相关的因素。结果:38%的患者患有eGFR结论:无论CKD分期如何,HFrEF伴CKD患者的心脏康复都是有益的。CKD的存在不应阻止HFrEF患者开具CR处方。
Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction.
Purpose: Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage.
Methods: We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ).
Results: Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results.
Conclusions: Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.
期刊介绍:
JCRP was the first, and remains the only, professional journal dedicated to improving multidisciplinary clinical practice and expanding research evidence specific to both cardiovascular and pulmonary rehabilitation. This includes exercise testing and prescription, behavioral medicine, and cardiopulmonary risk factor management. In 2007, JCRP expanded its scope to include primary prevention of cardiovascular and pulmonary diseases. JCRP publishes scientific and clinical peer-reviewed Original Investigations, Reviews, and Brief or Case Reports focused on the causes, prevention, and treatment of individuals with cardiovascular or pulmonary diseases in both a print and online-only format. Editorial features include Editorials, Invited Commentaries, Literature Updates, and Clinically-relevant Topical Updates. JCRP is the official Journal of the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.