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居家运动康复对重度主动脉瓣狭窄患者经导管主动脉瓣置换术后心脏结构和运动能力的影响

Effect of home-based exercise rehabilitation on cardiac structure and exercise capacity in patients with severe aortic stenosis after transcatheter aortic valve replacement

    摘要
  • 摘要:
    目的 探讨居家运动康复对主动脉瓣狭窄（aortic stenosis, AS）患者经导管主动脉瓣置换术（transcatheter aortic valve replacement, TAVR）术后心脏结构、瓣膜功能及运动能力的影响。
    方法 选择2024年1月至2025年2月于复旦大学附属中山医院接受TAVR治疗的重度AS患者49例，根据术后是否参与居家运动康复分为运动组（n＝25）和非运动组（n＝24）。运动组接受12周居家运动训练（每周进行有氧运动联合抗阻训练）；非运动组接受常规护理。采用经胸超声心动图评估患者出院前（T0）和运动训练12周后（T1）的心脏结构和瓣膜功能，比较两组患者6分钟步行试验（6-minute walk test, 6MWT）、Duke活动状态指数和简易躯体功能。采用线性混合效应模型分析居家运动康复对超声心动图参数的影响，并按基线6MWT进行分层（6MWT＜240 m为低功能亚组，6MWT≥240 m为高功能亚组），比较两亚组运动指标。
    结果 运动组T1时的6MWT距离长于非运动组（P＝0.012）。线性混合效应模型结果显示：12周后，运动组左心室舒张末期内径呈减小趋势，非运动组有轻微增大趋势，两组随时间的变化差异有统计学意义（P交互＝0.030）；运动组有效瓣口面积指数（P交互＝0.028）和有效瓣口面积（P交互＝0.042）改善均优于非运动组。亚组分析显示：低功能亚组中，运动组6MWT（P交互＝0.035）和有效瓣口面积指数（P交互＝0.046）改善优于非运动组；高功能亚组中，运动组仅左心室舒张末期内径改善优于非运动组（P交互＝0.046）。
    结论 居家运动康复可改善重度AS患者TAVR术后的运动能力，优化左室重构及瓣膜功能，在基线6MWT低功能者中获益更显著。

     

    Abstract:
    Objective To explore the effects of home-based exercise rehabilitation on cardiac structure, valvular function, and exercise capacity in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR).
    Methods 49 patients with severe AS who underwent TAVR at Zhongshan Hospital, Fudan University, from January 2024 to February 2025 were enrolled. They were divided into an exercise group (n＝25) or a non-exercise group (n＝24) based on participating or not in home-based rehabilitation after TAVR. The exercise group received 12 weeks of home-based exercise training (aerobic exercise plus resistance training every week); the non-exercise group received routine care. Transthoracic echocardiography (TTE) was used to assess cardiac structural parameters before discharge (T0) and after 12 weeks of exercise (T1). Functional outcomes including the 6-minute walk test (6MWT), Duke Activity Status Index (DASI), and Short Physical Performance Battery (SPPB) were compared between the two groups. A linear mixed-effects model was used to analyze the effect of home-based rehabilitation on echocardiographic parameters. Patients were stratified by baseline 6MWT (＜240 m as low-function subgroup, ≥240 m as high-function subgroup) to compare exercise-related outcomes between subgroups.
    Results At T1, the exercise group had a longer 6MWT distance than the non-exercise group (P＝0.012). The linear mixed-effects model showed that after 12 weeks of exercise, the left ventricular end-diastolic diameter (LVEDD) decreased in the exercise group but slightly increased in the non-exercise group, with a significant difference in changes over time between the two groups (Pinteraction＝0.030). The exercise group also showed greater improvement in effective orifice area index (Pinteraction＝0.028) and effective orifice area (Pinteraction＝0.042) than the non-exercise group. Subgroup analysis revealed that in the low-function subgroup, the exercise group showed greater improvement in the 6MWT (Pinteraction＝0.035) and the effective orifice area index (Pinteraction＝0.046) compared to the non-exercise group; in the high-function subgroup, the exercise group showed greater improvement only in LVEDD compared to the non-exercise group (Pinteraction＝0.046).
    Conclusions Home-based exercise rehabilitation improves exercise capacity, optimizes left ventricular remodeling, and enhances valvular function in patients with severe AS after TAVR, with greater benefits observed in patients with lower baseline 6MWT.

     

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