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Effect of Physical Exercise Training in Patients With Chagas Heart Disease (from the PEACH STUDY).

体育锻炼对恰加斯心脏病患者的影响 (来自PEACH研究)。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.01.035
  • 作者列表:"de Souza Nogueira Sardinha Mendes F","Mediano MFF","de Castro E Souza FC","da Silva PS","Carneiro FM","de Holanda MT","Saraiva RM","Xavier SS","Americano do Brasil PEA","de Sousa AS
  • 发表时间:2020-05-01
Abstract

:Chagas heart disease (HD) is a chronic fibrosing myocarditis with high mortality. The PEACH study aimed to evaluate if exercise training can improve the functional capacity of Chagas HD patients with left ventricular dysfunction and/or heart failure. The PEACH study was a single center, parallel-group, clinical trial that randomized 30 clinical stable Chagas HD patients with left ventricular ejection fraction <45% or heart failure symptoms to either supervised exercise training 3 times/week for 6 months or a control group. Both groups had the same monthly pharmaceutical and nutritional counseling and usual care. Primary end point was functional capacity assessed by peak exercise oxygen consumption (peak VO2) obtained by cardiopulmonary exercise test. Secondary end points included other cardiopulmonary exercise test variables, cardiac function by echocardiography, body composition, muscle respiratory strength, and metabolic biomarkers. Peak VO2 increased among patients in exercise group from 17.60 ± 4.65 mlO2 kg-1 min-1 to 19.40 ± 5.51 mlO2 kg-1 min-1 while decreased in controls from 15.40 ± 6.30 mlO2 kg-1 min-1 to 12.96 ± 4.50 mlO2 kg-1 min-1, resulting in significant difference in change in peak VO2 between groups after 6 months (β = +4.6, p = 0.004). There were significant differences between groups in changes in anaerobic threshold (β = 3.7, p = 0.05), peak oxygen pulse (β = +2.7, p = 0.032) and maximum minute ventilation (β = +13.9, p < 0.0001) after 6 months of intervention. In conclusion, exercise training improved functional capacity of chronic Chagas HD patients with left ventricular dysfunction and/or heart failure.

摘要

: 恰加斯心脏病 (Chagas heart disease,HD) 是一种慢性纤维化心肌炎,死亡率高。PEACH研究旨在评估运动训练是否可以改善伴有左心室功能障碍和/或心力衰竭的Chagas HD患者的功能能力。PEACH研究是一项单中心、平行组的临床试验,将30名左心室射血分数 <45% 或有心力衰竭症状的临床稳定的Chagas HD患者随机分组,接受3次/周监督运动训练,持续6个月或对照组。两组每月进行相同的药物和营养咨询和常规护理。主要终点是通过心肺运动试验获得的峰值运动耗氧量 (峰值VO2) 评估的功能能力。次要终点包括其他心肺运动试验变量、超声心动图测定的心脏功能、身体成分、肌肉呼吸强度和代谢生物标志物。运动组患者的VO2峰值从min-1的17.60 ± 4.65 mlO2 kg-1增加到min-1的19.40 ± 5.51 mlO2 kg-1,而对照组从min-1的15.40 ± 6.30 mlO2 kg-1降低到min-1的12.96 ± 4.50 mlO2 kg-1。导致6个月后组间VO2峰值变化有显著性差异 (β   =   + 4.6,p   =   0.004)。有显著性组间差异变化无氧阈 (β  =   3.7,p  =   0.05),峰值氧脉搏 (β  =   + 2.7,p  =   0.032) 和最大分钟通气量 (β  =   + 13.9,p <0.0001),干预6个月后.总之,运动训练改善了伴有左心室功能障碍和/或心力衰竭的慢性Chagas HD患者的功能能力。

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心肌病方向

心肌病是一组异质性心肌疾病,由不同病因引起心脏机械和电活动的异常,表现为心室不适当的肥厚或扩张。严重心肌病会引起心血管性死亡或进展性心力衰竭。心肌病通常分为原发性心肌病和继发性心肌病,其中原发性心肌病包括扩张型心肌病、肥厚型心肌病、限制型心肌病、致心律失常性右室心肌病和未定型心肌病。继发性心肌病指心肌病是全身性疾病的一部分。

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