Hemodynamic Determinants of Activity Measured by Accelerometer in Patients With Stable Heart Failure,JACC: Heart Failure

当前位置： X-MOL 学术 › JACC Heart Fail. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Hemodynamic Determinants of Activity Measured by Accelerometer in Patients With Stable Heart Failure
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2021-09-08 , DOI: 10.1016/j.jchf.2021.05.013
Massar Omar ₁ , Jesper Jensen ₂ , Peter H Frederiksen ₃ , Lars Videbæk ₄ , Mikael Kjær Poulsen ₄ , Jan Christian Brønd ₅ , Finn Gustafsson ₆ , Barry A Borlaug ₇ , Morten Schou ₂ , Jacob Eifer Møller ₈

Affiliation

Department of Cardiology, Odense University Hospital, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Department of Cardiology, Herlev and Gentofte University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Center for Research in Childhood Health/Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Division of Cardiovascular Diseases, Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota, USA.
Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

Objectives

This study examined the link between accelerometer recordings and cardiac pathophysiology measured with right heart cauterization at rest and with exercise in patients with HFrEF.

Background

Patient-worn accelerometers are increasingly being used in patients with heart failure with reduced ejection fraction (HFrEF) to assess activity and serve as surrogate endpoints in heart failure trials.

Methods

Physical average daily activity (PADA) and total average daily activity according to accelerometer units were assessed in 63 patients (mean age 58 ± 10 years; mean ejection fraction 26% ± 4%). Patients underwent hemodynamic exercise testing and accelerometry. Patients were divided according to PADA in PADA_Low and PADA_High activity level groups based on median counts per minute of physical activity.

Results

Patients in the PADA_Low group were older and more frequently treated with diuretics. At rest, the PADA_Low group was characterized by a lower cardiac index (2.2 ± 0.4 L/min/m² vs 2.4 ± 0.4 L/min/m²; P = 0.01) and stroke volume (70 ± 19 mL vs 81 ± 17 mL; P = 0.02) but not pulmonary capillary wedge pressure (12 ± 5 mm Hg vs 11 ± 5 mm Hg; P = 0.3). The PADA_Low group reached a lower cardiac index (4.8 ± 1.7 L/min/m² vs 6.6 ± 1.7 L/min/m²; P < 0.001) but not in pulmonary capillary wedge pressure (31 ± 12 mm Hg vs 27 ± 8 mm Hg; P = 0.2) at peak exercise. The attenuated increase was associated with an attenuated increase in stroke volume (94 ± 32 mL vs 121 ± 29 mL; P < 0.001) rather than a reduced increase in heart rate (42 ± 23 beats/min vs 52 ± 21 beats/min; P = 0.07). PADA and total average daily accelerometer units were associated with patient-reported functional impairment according to the Kansas City Cardiomyopathy Questionnaire but not with New York Heart Association functional class.

Conclusions

Among stable ambulatory patients with HFrEF, lower daily activity is associated with poorer cardiac index reserve and reduced cardiac index during exercise. (Empagliflozin in Heart Failure Patients With Reduced Ejection Fraction; NCT03198585)

中文翻译：

稳定型心力衰竭患者加速度计测量活动的血流动力学决定因素

目标

这项研究检查了加速度计记录与心脏病理生理学之间的联系，这些病理生理学是在 HFrEF 患者的休息时右心烧灼和运动时测量的。

背景

患者佩戴的加速度计越来越多地用于射血分数降低 (HFrEF) 的心力衰竭患者，以评估活动并作为心力衰竭试验的替代终点。

方法

在 63 名患者（平均年龄 58 ± 10 岁；平均射血分数 26% ± 4%）中评估了根据加速度计单位的身体平均每日活动 (PADA) 和总平均每日活动。患者接受了血流动力学运动测试和加速度计。根据 PADA_低和 PADA_高活动水平组中的 PADA 将患者分为基于每分钟身体活动的中位数计数。

结果

PADA _Low组的患者年龄较大，并且更频繁地接受利尿剂治疗。_{静息时，低}PADA组的特点是心脏指数较低（2.2 ± 0.4 L/min/m ²对比 2.4 ± 0.4 L/min/m ²；P = 0.01）和每搏输出量（70 ± 19 mL vs 81 ± 17 mL；P = 0.02）但不是肺毛细血管楔压（12 ± 5 mm Hg vs 11 ± 5 mm Hg；P = 0.3）。PADA _Low组的心脏指数较低（4.8 ± 1.7 L/min/m ²对比 6.6 ± 1.7 L/min/m ²；P < 0.001），但肺毛细血管楔压未达到（31 ± 12 mm Hg vs 27 ± 8 毫米汞柱；P =0.2) 在运动高峰期。减弱的增加与每搏输出量的减弱增加有关（94 ± 32 mL vs 121 ± 29 mL；P < 0.001）而不是心率增加的减少（42 ± 23 次/分钟 vs 52 ± 21 次/分钟；P = 0.07）。根据堪萨斯城心肌病问卷调查，PADA 和总平均每日加速度计单位与患者报告的功能障碍相关，但与纽约心脏协会功能等级无关。