Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was a multicenter, randomized controlled trial designed to examine the safety and efficacy of aerobic exercise training versus usual care in 2,331 patients with systolic heart failure (HF). In HF-ACTION patients with rest transthoracic echocardiographic measurements, the predictive value of 8 Doppler echocardiographic measurements-left ventricular (LV) diastolic dimension, mass, systolic (ejection fraction) and diastolic (mitral valve peak early diastolic/peak late diastolic [E/A] ratio, peak mitral valve early diastolic velocity/tissue Doppler peak early diastolic myocardial velocity [E/E'] ratio, and deceleration time) function, left atrial dimension, and mitral regurgitation severity-was examined for a primary end point of all-cause death or hospitalization and a secondary end point of cardiovascular disease death or HF hospitalization. Also compared was the prognostic value of echocardiographic variables versus peak oxygen consumption (Vo(2)). Mitral valve E/A and E/E' ratios were more powerful independent predictors of clinical end points than the LV ejection fraction but less powerful than peak Vo(2). In multivariate analyses for predicting the primary end point, adding E/A ratio to a basic demographic and clinical model increased the C-index from 0.61 to 0.62, compared with 0.64 after adding peak Vo(2). For the secondary end point, 6 echocardiographic variables, but not the LV ejection fraction or left atrial dimension, provided independent predictive power over the basic model. The addition of E/E' or E/A to the basic model increased the C-index from 0.70 to 0.72 and 0.73, respectively (all p values <0.0001). Simultaneously adding E/A ratio and peak Vo(2) to the basic model increased the C-index to 0.75 (p <0.0005). No echocardiographic variable was significantly related to the change from baseline to 3 months in exercise peak Vo(2). In conclusion, the addition of echocardiographic LV diastolic function variables improves the prognostic value of a basic demographic and clinical model for cardiovascular disease outcomes.

译文

心力衰竭:运动训练的对照试验研究结果(HF-ACTION)是一项多中心,随机对照试验,旨在检查有氧运动训练与常规护理相比对2331例收缩期心力衰竭(HF)患者的安全性和有效性。在进行静息经胸超声心动图测量的HF-ACTION患者中,8种多普勒超声心动图测量的预测价值-左心室(LV)舒张大小,质量,收缩压(射血分数)和舒张压(二尖瓣峰值舒张早期/峰值舒张末期[E / A]比,二尖瓣舒张早期峰值速度/组织多普勒峰值舒张早期心肌速度[E / E']比和减速时间)功能,左心房尺寸和二尖瓣关闭不全的严重程度-被作为所有患者的主要终点-导致死亡或住院,以及心血管疾病死亡或HF住院的次要终点。还比较了超声心动图变量与峰值耗氧量(Vo(2))的预后价值。二尖瓣E / A和E / E'比比LV射血分数更有效的临床终点独立预测因子,但不如峰值Vo(2)强大。在用于预测主要终点的多变量分析中,将E / A比添加到基本人口统计和临床模型中后,C指数从0.61增至0.62,而在增加峰值Vo(2)之后则为0.64。对于次要终点,6个超声心动图变量而不是LV射血分数或左心房尺寸对基本模型提供了独立的预测能力。在基本模型中添加E / E'或E / A会使C指数分别从0.70增加到0.72和0.73(所有p值<0.0001)。同时将E / A比和峰值Vo(2)添加到基本模型中会使C指数增加到0.75(p <0.0005)。没有超声心动图变量与运动峰值Vo(2)从基线到3个月的变化显着相关。总之,超声心动图左室舒张功能变量的增加改善了心血管疾病预后的基本人口统计学和临床​​模型的预后价值。

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