МЕХАНИЗМЫ СНИЖЕНИЯ ТОЛЕРАНТНОСТИ К ФИЗИЧЕСКОЙ НАГРУЗКЕ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Андрей Григорьевич Обрезан; Дмитрий Николаевич Перуцкий; Александр Александрович Зарудский

doi:10.21638/11701/spbu11.2017.402

Авторы

Андрей Григорьевич Обрезан Санкт-Петербургский государственный университет, Российская Федерация, 199034, Санкт-Петербург, Университетская наб., 7–9 ; Международный медицинский центр «СОГАЗ», Российская Федерация, 199000, Санкт-Петербург, ул. Малая Конюшенная, 8
Дмитрий Николаевич Перуцкий Белгородская областная клиническая больница Святителя Иоасафа, Российская Федерация, 308000, Белгород, ул. Некрасова, 8/9
Александр Александрович Зарудский Белгородская областная клиническая больница Святителя Иоасафа, Российская Федерация, 308000, Белгород, ул. Некрасова, 8/9

DOI:

https://doi.org/10.21638/11701/spbu11.2017.402

Аннотация

В течение последних пяти лет количество больных с хронической сердечной недостаточностью с сохранной фракцией выброса увеличилось с 38 до 54 %.Рост продолжительности жизни, а следовательно, и числа пациентов с картиной хронической сердечной недостаточности, в частности с сохранной фракцией выброса, формирует научный интерес к данной проблеме.Патофизиологические изменения в организме, определяющие развитие симптомокомплекса,характерного для данной патологии, в настоящее время активно изучаются. В данном обзоре представлены основные механизмы, ответственные за появление симптомов, характерных для пациентов с хронической сердечной недостаточностью: мышечная слабость, снижение толерантности к физической нагрузке,одышка.Детально освещены патофизиологические и патогенетические процессы, сопряженные с мышечной слабостью и одышкой у пациентов с хронической сердечной недостаточностью как сохранной, так и сниженной фракцией выброса.Библиогр. 46 назв.

Ключевые слова:

хроническая сердечная недостаточность, фракция выброса, одышка, мышечная слабость

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References

Hamilton A. L., Killian K. J., Summers E., Jones N. L. Muscle strength, symptom intensity, and exercis capacity in patients with cardiorespiratory disorders. Am. J. Respir. Crit. Care Med 1995, vol. 152, pp. 2021–2031.

Clark A. L., Sparrow J. L., Coats A. J. Muscle fatigue and dyspnea in chronic heart failure: two sides of the same coin? Eur. Heart Journal, 1995, vol. 16, pp. 49–52.

Lipkin D. P., Canepa-Anson R., Stephens M. R., Poole-Wilson P. A. Factors determining symptoms in heart failure: comparison of fast and slow exercise tests. Br. Heart J., 1986., vol. 55, pp. 439–445.

Witte K. K., Clark A. L. Cycle exercise causes a lower ventilatory response to exercise in chronic heart failure. Heart, 2005, vol. 91, pp. 225–226.

Davies S. W., Fussell A. L., Jordan S. L., Poole-Wilson P. A., Lipkin D. P. Abnormal diastolic filling

patterns in chronic heart failure: relationship to exercise capacity.Eur. Heart J., 1992, vol. 13, pp. 749–757.

Witte K. K., Nikitin N. P., De Silva R., Cleland J. G., Clark A. L. Exercise capacity and cardiac function assessed by tissue Doppler imaging in chronic heart failure. Heart, 2004, vol. 90, pp. 1144–1150.

Wilson J. R., Rayos G., Yeoh T. K., Gothard P. Dissociation between peak exercise oxygen consumption and hemodynamic dysfunction in potential heart transplant candidates. J. Am. Coll. Cardiol.,

1995, vol. 26,pp. 429–435.

Ciampi Q., Pratali L., Porta M. D., Petruzziello B., Manganiello V., Picano E. et al. Tissue Doppler

systolic velocity change during dobutamine stress echocardiography predicts contractile reserve and exercise tolerance in patients with heart failure. Eur. Heart J. Cardiovasc. Imaging, 2013, vol. 14, pp. 102–109.

Woods P. R., Olson T. P., Frantz R. P., Johnson B. D. Causes of breathing inefficiency during exercise in heart failure. Journal of Cardiac Failure, 2010, vol. 16, no. 10, pp. 835–842.

Agostoni P., Bussotti M., Cattadori G., Margutti E., Contini M., Muratori M., Marenzi G., Fiorentini

C. Gas diffusion and alveolar-capillary unit in chronic heart failure. Eur. Heart J. 2006, vol. 27, pp. 2538–2543.

Wasserman K., Zhang Y.-Y., Gitt A., Belardinelli R., Koike A., Lubarsky L., Agostoni P. G. Lung

function and exercises gas exchange in chronic heart failure. Circulation, 1997, vol. 96, pp. 2221–2227.

Agostoni P., Pellegrino R., Conca C., Rodarte J. R., Brusasco V. Exercise hyperpnea in chronic heart failure: relationships to lung stiffness and expiratory flow limitation. J. Appl. Physiol., 2002, vol. 92, pp. 1409–1416.

Bocchi E. A., Bacal F., Costa Auler J. O., Carvalho Carmone J. M., Bellotti G., Pillegi F. Inhaled nitric

oxide leading to pulmonale edema in stable severe heart failure. Am. J. Cardiol., 1994, vol. 74, pp. 70–72.

Ontrean M., Gay R., Greenberg B. Diminished endothelium-derived relaxing factor activiti on

experimental model of chronic heart failure. Circ. Res., 1991, vol. 69, pp. 1088–1096.

Agostoni P. G., Guazzi M., Bussotti M., Grazzi M., Palermo P., Marenzi G. Lack of improvement

of lung diffusing capacity following fluid withdrawal by ultrafiltration in chronic heart failure. J. Am. Coll.

Cardiol., 2000, vol. 36, pp. 1600–1604.

Chugh S. S., Chua T. P., Coats A. J. Peripheral chemoreflex in chronic heart failure: friend and foe.

Am. Heart J., 1996, vol. 132, pp. 900–904.

Chua T. P., Clark A. L., Amadi A. A., Coats A. J. Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J. Am. Coll. Cardiol., 1996, vol. 27, pp. 650–657.

Wasserman K., Beaver W. L., Sun X. G., Stringer W. W. Arterial H+ regulation during exercise in

humans. Respiratory physiology and neurobiology, 2011, vol. 178, no. 2, pp. 191–195.

Piepoli M., Ponikowski P., Clark A. L., Banasiak W., Capucci A., Coats A. J. A neural link to explain

the “muscle hypothesis” of exercise intolerance in chronic heart failure. Am. Heart J., 1999, vol. 137,

pp. 1050–1056.

Adreani C. M., Hill J. M., Kaufman M. P. Responses of group III and IV muscle afferents to dynamic exercise. J. Appl. Physiol., 1997, vol. 82, pp. 1811–1817.

Minotti J. R., Pillay P., Oka R., Wells L., Christoph L., Massie B. M. Skeletal muscle size: relationship to muscle function in heart failure. J. Appl. Physiol., 1993, vol. 75, pp. 373–381.

Libera L. D., Vescovo G., Volterrani M. Physiological basis for contractile dysfunction in heart

failure. Current Pharmaceutical Design, 2008, vol. 14, pp. 2572–2581.

Massie B., Conway M., Yonge R., Frostick S., Ledingham J., Sleight P. Skeletal muscle metabolism in patients with congestive heart failure: relation to clinical severity and blood flow. Circulation, 1987, vol. 76,pp. 1009–1019.

Schulze P. C., Linke A., Schoene N., Winkler S. M., Adams V., Conradi S., Busse M., Schuler G.,

Hambrecht R. Functional and morphological skeletal muscle abnormalities correlate with reduced

electromyographic activity in chronic heart failure. Eur. J. Cardiovasc. Prev. Rehabil., 2004, vol. 11, no. 2,pp. 155–161.

Middlekauff H. R. Making the case for skeletal myopathy as the major limitation of exercise capacity in heart failure. Circulation Heart Failure, 2010, vol. 3, no. 4, pp. 537–546.

Massie B. M., Simonini A., Sahgal P., Wells L., Dudley G. A. Relation of systemic and local muscle

exercise capacity to skeletal muscle characteristics in men with congestive HF. J. Am. Coll. Cardiol., 1996,vol. 27, pp. 140–145.

Williams A. D., Selig S., Hare D. L., Hayes A., Krum H., Patterson J., Geerling R. H., Toia D.,

Carey M. F. Reduced exercise tolerance in CHF may be related to factors other than impaired skeletal muscle

oxidative capacity. J. Card. Failure, 2004, vol. 10, pp. 141–148.

Packer M. The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure. J. Am. Coll. Cardiol., 1992, vol. 20, pp. 248–254.

Anker S. D., Chua T. P., Ponikowski P., Harrington D., Swan J. W., Kox W. J., Poole-Wilson P. A.,

Coats A. J. Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance

for cardiac cachexia.Circulation, 1997, vol. 96, pp. 526–534.

Kontoleon P. E., Anastasiou-Nana M. I., Papapetrou P. D., Alexopoulos G., Ktenas V., Rapti A. C.,

Tsagalou E. P., Nanas J. N. Hormonal profile in patients with congestive heart failure. Int. J. Cardiol., 2003,vol. 87, no. 2, pp. 179–183.

Sullivan M. J., Knight J. D., Higginbotham M. B. Relation between central and peripheral

hemodynamics during exercise in patients with chronic heart failure. Circulation, 1989, vol. 80, pp. 769–781.

Wilson J. R., Mancini D. M., Dunkman W. B. Exertional fatigue due to skeletal muscle dysfunction in patients with heart failure. Circulation, 1993, vol. 87, pp. 470–475.

Duscha B. D., Kraus W. E., Keteyian S. J., Sullivan M. J., Green H. J., Schachat F. H., Pippen A. M.,

Brawner C. A., Blank J. M., Annex B. H. Capillary density of skeletal muscle: a contributing mechanism for

exercise intolerance in class II–III chronic heart failure independent of other peripheral alterations. J. Am.

Coll. Cardiol., 1999, vol. 33, pp. 1956–1963.

Manetos C., Dimopoulos S., Tzanis G., Vakrou S., Tasoulis A., Kapelios C., Agapitou V., Ntalianis A.,Terrovitis J., Nanas S. Skeletal muscle microcirculatory abnormalities are associated with exercise intolerance,

ventilatory inefficiency, and impaired autonomic control in heart failure. J. Heart Lung Transplant., 2011, vol. 30, no. 12, pp. 1403–1408.

Clark A. L., Poole-Wilson P. A., Coats A. J. Exercise limitation in chronic heart failure: central role of the periphery. J. Am. Coll. Cardiol., 1996, vol. 28, pp. 1092–1102.

Kitzman D. W., Higginbotham M. B., Cobb F. R., Sheikh K. H., Sullivan M. J. Exercise intolerance

in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling

mechanism. J. Am. Coll. Cardiol., 1991, vol. 17, pp. 1065–1072.

Haykowsky M. J., Brubaker P. H., John J. M., Stewart K. P., Morgan T. M., Kitzman D. W. Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. J. Am. Coll. Cardiol.,2011, vol. 58, no. 3, pp. 265–274.

Borlaug B. A., Melenovsky V., Russell S. D., Kessler K., Pacak K., Becker L. C., Kass D. A. Impaired

chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved

ejection fraction. Circulation, 2006, vol. 114, pp. 2138–2147.

Little W. C., Borlaug B. A. Exercise intolerance in heart failure with preserved ejection fraction. Circ. Heart Fail., 2015, vol. 8, pp. 233–235.

Abudiab M. M., Redfield M. M., Melenovsky V., Olson T. P., Kass D. A., Johnson B. D., Borlaug B. A.Cardiac output response to exercise in relation to metabolic demand in heart failure with preserved ejection

fraction. Eur. J. Heart Fail., 2013, vol. 15, pp. 776–785.

Wagner P. D. Determinants of maximal oxygen transport and utilization. Annu. Rev. Physiol., 1996,vol. 58, pp. 21–50.

Dhakal B. P., Malhotra R., Murphy R. M., Pappagianopoulos P. P., Baggish A. L., Weiner R. B.,

Houstis N. E., Eisman A. S., Hough S. S., Lewis G. D. Mechanisms of exercise intolerance in heart failure with preserved ejection fraction. Circ. Heart Fail., 2015, vol. 8, pp. 286–294.

Santos M., Opotowsky A. R., Shah A. M., Tracy J., Waxman A. B., Systrom D. M. Central cardiac

limit to aerobic capacity in patients with exertional pulmonary venous hypertension: implications for heart

failure with preserved ejection fraction. Circ. Heart Fail., 2015, vol. 8, pp. 278–285.

Kitzman D. W., Nicklas B., Kraus W. E., Lyles M. F., Eggebeen J., Morgan T. M., Haykowsky M.

Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved

ejection fraction. American Journal of Physiology. Heart and Circulatory Physiology, 2014, vol. 306, no. 9,pp. 1364–1370.

Haykowsky M., Kouba E. J., Brubaker P. H., Nicklas B. J., Eggebeen J., Kitzman D. W. Skeletal muscle composition and its relation to exercise intolerance in older patients with heart failure and preserved

ejection fraction. Am. J. Cardiol., 2014, vol. 113, pp. 1211–1216.

Borlaug B. A., Olson T. P., Lam C. S. P., Flood K. S., Lerman A., Johnson B. D., Redfield M. M. Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J. Am. Coll.

Cardiol.,2010, vol. 56, no. 11, pp. 845–854.