Influence of physical rehabilitation on oxygen and lactate status in "inotrope-dependent" patients with chronic heart failure in class III–IV
- Authors: Bortsova M.A.1, Demchenko E.A.1, Bautin A.E.1, Fedotov P.A.1, Marichev A.O.1, Fedorova M.A.1, Korneva L.O.1, Sitnikova M.Y.1
-
Affiliations:
- Almazov National Medical Research Centre
- Issue: Vol 12, No 3 (2021)
- Pages: 147-157
- Section: Original study articles
- URL: https://journals.rcsi.science/2221-7185/article/view/83284
- DOI: https://doi.org/10.17816/22217185.2021.3.201027
- ID: 83284
Cite item
Full Text
Abstract
Aim. To assess the effect of physical rehabilitation on dynamics of oxygen and lactate status indicators in “inotrope-dependent” patients with stable chronic heart failure (CHF) of III–IV functional class (FC).
Material and methods. A randomized prospective study included 120 men, aged 18–65, hospitalized at Almazov National Medical Research Centre due to CHF III–IV FC, left ventricular ejection fraction (LVEF) ≤30%; with blood pressure (BP)≥90/60 mm Hg. Patients who received dobutamine or dopamine for ≥2 weeks were randomized into 3 groups: 1st – participating in the program of physical training (PPT), 2nd – not participating; 3rd group – patients without inotropic support participating in PPT.
Results. Oxygen extraction ratio (O2ER) at rest was increased, while central venous oxygen saturation (ScvO2) was decreased in all groups at baseline, after 3 and 6 months. Initially, at rest, central venous blood lactate (lactate) was normal in all groups. By the 6th month, lactate in group 2 became higher than in group 1 (p=0.005) and group 3 (p=0.008). Initially, after 3 and 6 months, at peak of exercise in groups 1 and 3, lactate and O2ER increased, and ScvO2 decreased without development of life-threatening adverse events. By the 6th month, in groups 1 and 3, the distance of 6-minute walk test increased: p=0.004 and p<0.00001 and the strength of hand muscles increased: p=0.01 and p=0.005.
Conclusion. In patients with CHF III–IV FC at rest, regardless of participation in PPT and inotropic therapy, there were comparable disturbances of oxygen status, characterized by decreased level of ScvO2 and increased level of O2ER, in the absence of decrease in arterial blood saturation. At peak of aerobic exercise of mild and moderate intensity in patients with advanced CHF, regardless of inotropic support, there was a comparable increase in the level of lactate and O2ER, as well as a decrease in ScvO2, which was not accompanied by life-threatening adverse events. The participation of “inotrope-dependent” patients in PPT is associated with decrease in blood lactate at rest, which, along with increase in hand muscle strength and exercise tolerance, may indicate an improvement in condition of muscle tissue.
Full Text
##article.viewOnOriginalSite##About the authors
Maria A. Bortsova
Almazov National Medical Research Centre
Author for correspondence.
Email: marja_@mail.ru
Head of Cardiology Department №8
Russian Federation, Saint PetersburgElena A. Demchenko
Almazov National Medical Research Centre
Email: demchenko_ea@almazovcentre.ru
ORCID iD: 0000-0002-7173-0575
D. Sci. (Med.)
Russian Federation, Saint PetersburgAndrey E. Bautin
Almazov National Medical Research Centre
Email: abautin@mail.ru
ORCID iD: 0000-0001-5031-7637
D. Sci. (Med.), Assoc. Prof.
Russian Federation, Saint PetersburgPetr A. Fedotov
Almazov National Medical Research Centre
Email: drheart@mail.ru
ORCID iD: 0000-0002-7452-1971
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgAleksandr O. Marichev
Almazov National Medical Research Centre
Email: marichevalexander@gmail.com
ORCID iD: 0000-0002-7753-118X
Cand. Sci. (Med.)
Russian Federation, Saint PetersburgMaria A. Fedorova
Almazov National Medical Research Centre
Email: skada-14@mail.ru
ORCID iD: 0000-0003-3291-6884
Res. Assist., Almazov National Medical Research Centre
Russian Federation, Saint PetersburgLubov O. Korneva
Almazov National Medical Research Centre
Email: ljubovkornewa@yandex.ru
ORCID iD: 0000-0002-6503-0310
Res. Assist.
Russian Federation, Saint PetersburgMaria Y. Sitnikova
Almazov National Medical Research Centre
Email: drsitnikova@mail.ru
ORCID iD: 0000-0002-0139-5177
D. Sci. (Med.), Prof.
Russian Federation, Saint PetersburgReferences
- Jugdutt BI, Michorowski BL, Kappagoda CT. Exercise training after anterior Q wave myocardial infarction: importance of regional left ventricular function and topography. J Am Coll Cardiol. 1988;12:362-72. doi: 10.1016/0735-1097(88)90407-X
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200.doi: 10.1093/eurheartj/ehw128
- Мареев В.Ю., Фомин И.В., Агеев Ф.Т., и др. Клинические рекомендации. Хроническая сердечная недостаточность (ХСН). Сердечная недостаточность. 2017;18(1):3-40 [Mareev VYu, Fomin IV, Ageev FT, et al. Clinical guidelines. Chronic heart failure (CHF). Heart Failure. 2017;18(1):3-40 (in Russian)].doi: 10.18087/rhfj.2017.1.2346
- Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П., и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Утверждены на Конгрессе ОССН 7 декабря 2012 г., на Правлении ОССН 31 марта 2013 г. и Конгрессе РКО 25 сентября 2013 г. Сердечная недостаточность. 2013;14(7):379-472 [Mareev VIu, Ageev FT, Arutiunov G.P., et al. Natsional'nye rekomendatsii OSSN, RKO i RNMOT po diagnostike i lecheniiu KhSN (chetvertyi peresmotr). Utverzhdeny na Kongresse OSSN 7 dekabria 2012 g., na Pravlenii OSSN 31 marta 2013 g. i Kongresse RKO 25 sentiabria 2013 g. Heart Failure. 2013;14(7):379-472 (in Russian)]. doi: 10.18087/rhfj.2013.7.1860
- Piepoli MF, Conraads V, Corrà U, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011;13(4):347-57.doi: 10.1093/eurjhf/hfr017
- Narula J, Haider N, Virmani R, et al. Apoptosis in myocytes in endstage heart failure. N Engl J Med. 1996;335(16):1182-9. doi: 10.1056/NEJM199610173351603
- Krell MJ, Kline EM, Bates ER, et al. Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure. Am Heart J. 1986;112(4):787-91.doi: 10.1016/0002-8703(86)90475-8
- Weber KT, Kinasewitz GT, Janicki JS, Fishman AP. Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure. Circulation. 1982;65(6):1213-23. doi: 10.1161/01.cir.65.6.1213
- Kataoka T, Keteyian SJ, Marks CR, et al. Exercise training in a patient with congestive heart failure on continuous dobutamine. Med Sci Sports Exerc. 1994;26(6):678-81. doi: 10.1249/00005768-199406000-00004
- Amiya E, Taya M. Is Exercise Training Appropriate for Patients With Advanced Heart Failure Receiving Continuous Inotropic Infusion? A Review. Clin Med Insights Cardiol. 2018;12:1179546817751438. doi: 10.1177/1179546817751438
- Taya M, Amiya E, Hatano M, et. al. High-intensity aerobic interval training can lead to improvement in skeletal muscle power among in-hospital patients with advanced heart failure. Heart Vessels. 2018;33(7):752-9. doi: 10.1007/s00380-018-1120-x
- Борцова М.А., Демченко Е.А., Федотов П.А., и др. Безопасность и эффективность физических тренировок у инотроп-зависимых пациентов с компенсацией хронической сердечной недостаточности на уровне III–IV функционального класса. CardioСоматика. 2019;10(3):6-12 [Bortsova MA, Demchenko EA, Fedotov PA, et al. Safety and effectiveness of physical training in inotrop-dependent patients with compensation for chronic heart failure at the level of the III–IV functional class. Cardiosomatics. 2019;10(3):6-12 (in Russian)]. doi: 10.26442/22217185.2019.3.190442
- Борцова М.А., Демченко Е.А., Баутин А.Е., и др. Влияние физических тренировок на функциональные и гемодинамические показатели пациентов с хронической сердечной недостаточностью III–IV функционального класса в зависимости от потребности в инотропной поддержке. Артериальная гипертензия. 2020;26(5):526-42 [Bortsova MA, Demchenko EA, Bautin AE, et.al. Impact of physical training on functional and haemodynamic characteristics of “inotrope-dependent” patients with chronic heart failure at class III–IV. Arterial Hypertension. 2020;26(5):526-42 (in Russian)]. doi: 10.18705/1607-419X-2020-26-5-526-542
- Poole DC, Hirai DM, Copp SW, Musch TI. Muscle oxygen transport and utilization in heart failure: implications for exercise (in)tolerance. Am J Physiol Heart Circ Physiol. 2012;302(5):H1050-63. doi: 10.1152/ajpheart.00943.2011
- Hirai DM, Musch TI, Poole DC. Exercise training in chronic heart failure: improving skeletal muscle O2 transport and utilization. Am J Physiol Heart Circ Physiol. 2015;309(9):H1419-39. doi: 10.1152/ajpheart.00469.2015
- Poole DC, Richardson RS, Haykowsky MJ, et al. Exercise limitations in heart failure with reduced and preserved ejection fraction. J Appl Physiol (1985). 2018;124(1):208-24. doi: 10.1152/japplphysiol.00747.2017
- Янсен П. ЧСС, лактат и тренировки на выносливость. Пер. с англ. Мурманск: Тулома, 2006 [Jansen P. Heart rate, lactate and endurance training. Transl. from English. Murmansk: Tuloma, 2006 (in Russian)].
- Hopker JG, Jobson SA, Pandit JJ. Controversies in the physiological basis of the ‘anaerobic threshold’ and their implications for clinical cardiopulmonary exercise testing. Anaesthesia. 2011;66(2):111-23. doi: 10.1111/j.1365-2044.2010.06604.x
- Лелявина Т.А., Ситникова М.Ю., Березина А.В., и др. Диагностическая и прогностическая значимость определения лактатного порога и рН-порога в ходе кардиореспираторного теста у больных хронической сердечной недостаточностью. Медицинский алфавит. 2014;1(3):25-7 [Lelyavina TA, Sitnikova MYu, Berezina AV, et al. Diagnostic and prognostic value of determination lactate threshold and pH threshold during the cardiorespiratory test in patients with chronic cardiac failure. Medical Alphabet. 2014;1(3):25-7 (in Russian)].
- Fitts RH. The cross-bridge cycle and skeletal muscle fatigue. J Appl Physiol (1985). 2008;104(2):551-8.doi: 10.1152/japplphysiol.01200.2007
- Костюченко С.С. Кислотно-щелочной баланс в интенсивной терапии. 2-е изд. Минск, 2009 [Kostyuchenko SS. Acid-base balance in intensive care. 2nd ed. Minsk, 2009 (in Russian)].
- Марино П.Л. Интенсивная терапия. Пер. с англ. Ред. А.И. Мартынов. М.: ГЭОТАР МЕДИЦИНА, 1998 [Marino PL. Intensive therapy. Transl. from English. Ed. AI Martynov. Moscow: GEOTAR MEDICINE, 1998 (in Russian)].
- Cardús J, Marrades RM, Roca J, et al. Effects of F(I)O2 on leg VO2 during cycle ergometry in sedentary subjects. Med Sci Sports Exerc. 1998;30(5):697-703. doi: 10.1097/00005768-199805000-00009
- Wagner PD. New ideas on limitations to VO2max. Exerc Sport Sci Rev. 2000;28(1):10-4.
- Esposito F, Mathieu-Costello O, Shabetai R, et al. Limited maximal exercise capacity in patients with chronic heart failure: partitioning the contributors. J Am Coll Cardiol. 2010;55(18):1945-54. doi: 10.1016/j.jacc.2009.11.086
- Арутюнов Г.П. Кахексия у больных с хронической сердечной недостаточностью. Каков масштаб проблемы? Что мы знаем и что нам делать? ЖСН. 2001;2(3):101 [Arutiunov GP. Kakheksiia u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu. Kakov masshtab problemy? Chto my znaem i chto nam delat'? ZhSN. 2001;2(3):101 (in Russian)].
- Schutz Y, Kyle UUG, Pichard C. Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y. Int J Obes Relat Metab Disord. 2002;26(7):953-60. doi: 10.1038/sj.ijo.0802037
- Swedberg K, Cleland J, Dargie H, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur Heart J. 2005;26(11):1115-40. doi: 10.1093/eurheartj/ehi204
- Overgaard CB, Dzavík V. Inotropes and vasopressors: review of physiology and clinical use in cardiovascular disease. Circulation. 2008;118(10):1047-56.doi: 10.1161/CIRCULATIONAHA.107.728840
- Арутюнов Г.П., Колесникова Е.А., Беграмбекова Ю.Л., и др. Рекомендации по назначению физических тренировок пациентам с хронической сердечной недостаточностью. Сердечная недостаточность. 2017;18(1):41-66 [Arutyunov GP, Kolesnikova EA, Begrambekova YuL, et al. Exercise training in chronic heart failure: practical guidance of the Russian heart failure society. Heart Failure. 2017;18(1):41-66 (in Russian)]. doi: 10.18087/rhfj.2017.1.2339
- Кузьков В.В., Киров М.Ю. Инвазивный мониторинг гемодинамики в интенсивной терапии и анестезиологии. 2-е изд. Архангельск: Северный государственный медицинский университет, 2015 [Kuzkov VV, Kirov MYu. Invasive hemodynamic monitoring in intensive care and anesthesiology. 2nd ed. Arkhangelsk: Northern State Medical University, 2015 (in Russian)].
- Crespo-Leiro MG, Metra M, Lund LH, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018;20(11):1505-35.doi: 10.1002/ejhf.1236
- Tucker WJ, Beaudry RI, Liang Y, et al. Meta-analysis of exercise training on left ventricular ejection fraction in heart failure with reduced ejection fraction: a 10-year update. Progress Cardiovasc Dis. 2019;62(2):163-71. doi: 10.1016/j.pcad.2018.08.006
- Лелявина Т.А., Ситникова М.Ю., Галенко В.Л., и др. Длительные аэробные тренировки способствуют развитию физиологического обратного ремоделирования миокарда у больных хронической сердечной недостаточностью. Медицинский алфавит. 2017;1(13):16-9 [Lelyavina TA, Sitnikova MY, Galenko VL, et al. Prolonged aerobic trainings cause reverse myocardial remodeling in heart failure patients. Medical Alphabet. 2017;1(13):16-9 (in Russian)].
- Shah MR, O'Connor CM, Sopko G, et al. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE): Design and rationale. Am Heart J. 2001;141(4):528-35. doi: 10.1067/mhj.2001.113995
- O’Connor CM, Gattis WA, Uretsky BU, et al. Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: Insights from the Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1999;138:78-86.doi: 10.1016/s0002-8703(99)70250-4.