Evaluation And Guidance Of Cardiac Reha-Bilitation In Patients With Heart Failure By Cardiopulmonary Exercise Test

Heart failure(HF)is a progressive increased clinical syndrome,seriously affecting the quality of life of patients.Cardiac rehabilitation as an important secondary prevention content,has got more and more attention from clinical medical workers.Sports rehabilitation is the core content,so exercise tolerance assessment is essential for rehabilitation guidance,often use cardiopulmonary exercise test(CPET)as a means of evaluation.Cardiac rehabilitation research and development is still in its infancy,especially in the lack of understanding of cardiac exercise,research on it is still small,there are still many problems.How to determine the patient’s cardiopulmonary function through the cardiopulmonary exercise test,to develop the exercise prescription,to guide the patients to recover the heart,so as to improve the quality of life of patients,control the risk factors,reduce the hospital re-admission and mortality rate,economic burden of patients,the social burden,bring better economic and social benefits,is worthy of discussion by medical and nursing workers on cardiovascular diseases.This study will be divided into the following two parts:(1)Discussion on evidence of cardiopulmonary exercise termination test,providing a reference for clinical works on CPET termination criteria.(2)The study of using cardiopulmonary exercise test to guide and evaluate exercise rehabilitation in patients with chronic heart failure,with a view to explore whether cardiac rehabilitation can significantly improve the exercise capacity of patients with left heart failure and how much exercise prescription for heart failure patients is properly to achieve maximum recovery.Part one Discussion on indicators of cardiopulmonary exercise termination testObjective:To reanalyze the heart rate,blood pressure and RER data of CPET patients with a maximum limit in order to investigate the indication of 85%maximum rate of heart rate(MPHR),systolic blood pressure threshold and how high RER should be based on in CPET termination test.Methods:Select 80 subjects completed 112 CPET in the book of the fourth edition of Principles of Exercise Testing and Interpretation from January 1974 to January 2005 at the CPET Laboratory in University of California,Los Angeles.Calculate and analyze:1)The differences and%difference of the observed indicators in CPET;2)There are a total of 98 times CPET except 14 cases without direct arterial pressure.Complete the symptom and maximum limited CPET according to the standard continuous incremental power scheme.Count the difference and%difference of the observed indicators when the systolic blood pressure reached or exceeded 210,220,240,250 mm Hg in CPET among groups;3)There are a total of 101 times CPET except 10 cases without oxygen intake and RER due to absorption of pure oxygen and 1 case without RER related data.Complete the symptom and maximum limited CPET according to the standard continuous incremental power scheme.Respectively,count the difference between the indicators in maximum limited exercise during the peak RER reached and exceeded 1.10,1.15,1.20,%difference =(maximum-the corresponding value when reached a blood pressure when)/maximum.Results:There are 64(57.1%)subjects reached and exceeded 85%of MPHR of the 111 patients who completed the symptom and maximum limited CPET.The exercise time was(8.6 ± 1.9)min,the difference was(1.8 ± 4.3))W,%difference was(17 ± 80);the power was(136 ± 70)W,and the difference was(32 ± 26)W,%difference was(25 ±18).39 patients(39.8%)had a systolic blood pressure more than 210 mm Hg of 98 subjects completed symptom and maximum limited CPET.The exercise time was(7.32± 2.20)min,the difference was(2.8 ± 2.8)min,%difference was(43 ± 43);the power was(114.41 ± 53.44)W,the difference was(40 ± 39)W,%difference was(40 ± 37);28 cases(28.6%)had a systolic blood pressure more than 220 mm Hg of 98 subjects completed symptom and maximum limited CPET.The exercise time was(7.2 ±2.4)min,the difference was(2.3 ± 2,0)min,%difference was(38 ± 41);the power was(111 ±50)W,the difference was(35 ± 31)W,9%difference was(36 ± 35);13 subjects(13.3%)had a systolic blood pressure more than 240 mm Hg of 98 subjects completed symptom and maximum limited CPET.The exercise time was(6.65 ± 1.94)min,the difference was(2.8 ± 2.5)min,the difference was(43 ± 43);the power was(25.00 ± 3.82)W,the difference was(40 ± 39)W,9%difference was(40 ± 37);9 subjects(9.2%)had a systolic blood pressure more than 250 mm Hg of 98 subjects completed symptom and maximum limited CPET.The exercise time was(6.4 ± 2.3)min,the difference was(1.9± 2.7)min,the difference was(32 ± 42);the power was(91 ± 45)W,the difference was(27 ± 32)W,%difference was(34 ± 41).The peak RER of the 102 patients was 0.86-1.77,the mean was(1.21 ± 0.16),the peak RER reached and exceeded 1.10,1.15 and 1.20 have 77,60,50 cases respectively.Compared with the RER reached 1.10,1.15 and 1.20,the peak time of exercise was 2.43 ± 1.89,1.98 ± 1.71 and 1.45 ± 1.35min respectively.The oxygen uptake increased by 0.30 ± 0.31,0.27 ± 0.31 and 0.16 ± 0.18(L/min)respectively.At the same time,RER of 7 cases in extreme exercise is still less than 1.0,accounting for 7%.Conclusions:Individualized CPET should be the most extreme exercise for patients achieved symptomatic limitations.It is not possible to accurately assess the true level of cardiopulmonary function in patients with an 85%MPHR in termination test.If using a specific blood pressure as a standard in termination test,it can underestimate the functional status of patients,especially in patients with hypertensive tendencies and hypertensive patients will be seriously underestimated the overall functional status and exercise tolerance.In practice,neither can we use a specific RER value to terminate CPET,the error leads to a decrease in peak oxygen consumption;nor can use reaching a certain RER value as the patient’s "symptom limit" exercise,resulting in excessive risk.Part two Guidance and evaluation of exercise rehabilitation in patients with heart failure by cardiopulmonary exerciseObjective:To evaluate the changes of cardiopulmonary function in patients with chronic heart failure(CHF)by objective and quantitative assessment of cardiopulmonary exercise.To explore the effect of exercise rehabilitation on cardiopulmonary function,exercise tolerance and quality of life of CHF patients.Methods:Twenty patients with CHF were diagnosed in Beijing Rehabilitation Hospital from August 2014 to May 2016.After admission,the investigators asked the patients about the history of CHF and obtained the basic clinical data.All patients were randomly divided into two groups:rehabilitation group and control group.All patients underwent a comprehensive assessment of cardiopulmonary exercise function and other cardiac function parameters,including CPET,echocardiography,BNP,6-minute walking distance(6MWD)and Quality of life(QoL)score.In the control group,only with the general guidance.Use the cardiopulmonary exercise test to give objective and quantitative assessment on the rehabilitation group to develop individualized exercise prescription for exercise rehabilitation.Use 100-110%oxygenless exercise intensity,exercise time has 40min,including 5min warming-up and 5min rest;exercise frequency is 1 week 5 times.All patients were assessed again on other cardiac function indicators after 3 months of cardiopulmonary exercise.Results:After 3 months of exercise,AT were increased by 27.7%(P<0.01)in the control group and 20.8%(P<0.05),and the peak VO2 increased by 29.3%(P<0.05);peak VO2 increased by 24.3%(P<0.05);oxygen pulse increased by 23.4%(P<0.05);peak VO2 and oxygen pulse showed an increase in the percentage of predicted value,but the difference was not significant(P>0.05).Compared with the rehabilitation group,AT,peak VO2 and oxygen pulse were significantly increased after 3 months of exercise(P<0.05).(P<0.05),peak VO2 per kilogram of body weight increased by 18.9%(P<0.05),peak VO2 increased by 21.3%(P<0.01)(P<0.05),and the percentage of predicted value increased by 14.4%(P<0.05),and the percentage of predicted value increased by 14.8%(P<0.05).Comparison between groups:After 3 months,the level of BNP in the rehabilitation group was higher than that in the control group(P<0.05).The difference was statistically significant(P<0.05).After 3 months,the 6WMD in the rehabilitation group was lower than that in the control group(P<0.05).After 3 months,the QOL of the rehabilitation group was lower than that of the control group(P<0.01)The(P<0.05).After 3 months,6MWD in the rehabilitation group decreased,the difference was statistically significant(P<0.01).After 3 months,the difference was statistically significant(P<0.01),and the difference was statistically significant(P<0.01).Conclusions:The cardiopulmonary exercise test was used to evaluate and guide the development of individualized high-intensity exercise prescriptions.After 3 months of rehabilitation,the cardiopulmonary exercise function and quality of life of patients with chronic heart failure can be improved significantly.Cardiac rehabilitation is an important part of CHF secondary prevention and should be promoted.