老年慢性左心衰竭与右心衰竭患者心肺运动试验特点比较

摘要

ObjectiveTo compare the features of the parameters of cardiopulmonary exercise testing (CPET) between the elderly patients with chronic left heart failure (LHF) and those with chronic right heart failure (RHF).Methods A prospective study was carried out on 25 elderly patients with chronic LHF [20 males, aged (60.2±4.7) years] and 25 elderly patients with chronic RHF [(19 males, aged (61.3±5.7) years]. Those patients with pulmonary diseases, neuromuscular diseases and/or anemia were excluded. Valuables of CPET were compared between the 2 groups.Results There was no significant difference in the gender, age, BMI and New York Heart Association (NYHA) class between the 2 groups. Echocardiography indicated that left ventricular end-diastolic diameter was significantly larger in the LHF group than in the RHF group [(66.1±9.0)vs (40.4±5.4)mm,P<0.001], left ventricular ejection fraction was obviously lower in the former than in the latter group [(32.5±11.9)%vs (65.8±8.1)%,P<0.001]. LHF group had remarkably larger peak VO2 [(1056.6±340.5)vs (750.9±269.1)ml/min], higher peak VO2/kg [(15.1±2.7)vs (11.0±3.2)ml/(min·kg)] and percentage of predicted value of peak VO2 [(52±13)%vs (39±11)%] when compared with those of RHF group (P<0.05). Peak VO2/HR was significantly lower in the RHF group than in the LHF group [(6.3±2.2)vs (8.5±3.0)ml/(min·beat),P=0.016]. Compared with LHF group, VO2/WR slope was obviously decreased in RHF group [(5.1±1.1)vs (6.4±1.8)ml/(min·W),P=0.014], and VE/VCO2 slope was significantly higher [(34.7±8.2)vs (49.5±12.6),P<0.001].Conclusion Compared with LHF, cardiopulmonary functions are worse and VE/VCO2 slope is higher in the patients with RHF, even when having similar NYHA class.%目的：比较老年慢性左心衰竭与右心衰竭患者心肺运动试验（CPET）特点。方法入选老年非瓣膜性慢性左心衰竭患者25例[男性20例，年龄（60.2±4.7）岁]，以及年龄、性别、纽约心脏联合会（NYHA）心功能分级匹配的慢性右心衰竭患者25例[男性19例，年龄（61.3±5.7）岁]，排除合并肺部疾病、神经肌肉疾病或贫血等患者，对比其CPET特点。结果两组患者年龄、性别、体质量指数（BMI）、NYHA心功能分级无明显差异，超声心动图左心室舒张末内径左心衰竭组明显大于右心衰竭组，分别为（66.1±9.0）和（40.4±5.4）mm，左心衰竭组左室射血分数明显低于右心衰竭组，分别为（32.5±11.9）%和（65.8±8.1）%（P＜0.001）。CPET结果显示，左心衰竭组峰值氧耗量（peak VO2）为（1056.6±340.5）ml/min，峰值单位千克体质量的氧耗量（peak VO2/kg）为（15.1±2.7）ml/（min·kg），peak VO2占预计值的百分比为（52±13）%，右心衰竭组分别为（750.9±269.1）ml/min，（11.0±3.2）ml/（min·kg）和（39±11）%，右心衰竭组较左心衰竭组明显降低（P＜0.05）。右心衰竭组峰值氧脉搏（VO2/HR）明显低于左心衰竭组[（6.3±2.2） vs （8.5±3.0）ml/（min·beat），P＝0.016]。右心衰竭组氧耗量与功率比值斜率（VO2/WR slope）明显低于左心衰竭组[（5.1±1.1） vs （6.4±1.8）ml/（min·W），P＝0.014]。与左心衰竭组相比，右心衰竭组每分通气量/每分二氧化碳生量成斜率（VE/VCO2 slope）明显升高[（34.7±8.2）vs（49.5±12.6），P＜0.001]。结论与左心疾病所致左心衰竭患者相比，即使是相似的NYHA心功能分级，右心衰竭患者运动状态下的心肺功能更差，VE/VCO2 slope更高。