Abstract：【Objective】 To explore the clinical efficacy of cardiac exercise rehabilitation (CER) combined with tolvaptan in patients with heart failure (HF). 【Methods】 A total of 105 HF patients admitted to the Cardiac Rehabilitation Department of our hospital from February 2023 to October 2024 were selected and divided into three groups by random number table, with 35 cases in each group. Control group A received conventional anti-heart failure therapy plus CER intervention; Control group B received conventional anti-heart failure therapy plus tolvaptan intervention; Observation group received conventional anti-heart failure therapy combined with both CER and tolvaptan intervention. Cardiac function indicators [left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) cardiac function classification, brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP)], pulmonary function indicators [forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), percutaneous arterial oxygen saturation (SpO2)], clinical symptoms [Medical Research Council (MRC) dyspnea scale score, 24-hour urine volume, 6-minute walking distance (6MWD)], biochemical indicators [serum sodium (Na+), serum potassium (K+), serum creatinine (SCr), blood urea nitrogen (BUN)] and the incidence of adverse cardiovascular events were compared among the three groups before and after treatment. 【Results】 After treatment, LVEF increased, NYHA classification, serum BNP and NT-proBNP levels decreased in all three groups, with statistically significant intergroup differences (P<0.05). FVC and SpO2 of the three groups were significantly improved compared with baseline, FEV1/FVC rose markedly (P<0.05); the improvement of FVC and SpO2 in observation group was superior to two control groups (P<0.05). The MRC scores of all groups declined, and observation group had lower scores than the two controls (P<0.05). The 24-hour urine volume of control group A and B decreased after treatment (P<0.05), while that of observation group increased and was significantly higher than the two controls (P<0.05). The 6MWD of observation group increased obviously and was longer than the two controls (P<0.05). Serum Na+ of all three groups elevated after treatment with significant intergroup differences (P<0.05). Serum SCr decreased in each group (P<0.05), without statistical difference between groups (P>0.05). BUN levels dropped in all groups and showed significant intergroup differences (P<0.05). There was no significant difference in the incidence of adverse cardiovascular events among three groups (P>0.05). 【Conclusions】 CER combined with tolvaptan can improve cardiac function, relieve clinical symptoms and optimize biochemical indicators in heart failure patients with favorable safety profile and reduced readmission rate.
[1] SALIMIAN S, VIRANI S A, ROSTON T M, et al. Impact of the method of calculating 30-day readmission rate after hospitalization for heart failure. Data from the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry[J].Eur Heart J Qual Care Clin Outcomes,2024,10(6):523-530. [2] KUMAR A, IQBAL U, AMIN S B, et al. Evaluating the safety and effectiveness of tolvaptan in patients with heart failure and renal impairment: a systematic review and meta-analysis[J].Eur J Clin Pharmacol,2024: 1-14. [3] 葛书萍,陈伟,贾欣欣,等. 以个体化运动训练为核心的心脏康复方案对冠心病患者经皮冠状动脉介入治疗后康复效果的影响[J].实用医学杂志,2024,40(18):2607-2611. [4] 中华医学会心血管病学分会,中国医师协会心血管内科医师分会,中国医师协会心力衰竭专业委员会,等. 中国心力衰竭诊断和治疗指南2024[J].中华心血管病杂志,2024,52(3):235-275. [5] BREDY C, MINISTERI M, KEMPNY A, et al. New York Heart Association (NYHA) classification in adults with congenital heart disease: relation to objective measures of exercise and outcome[J].Eur Heart J Qual Care Clin Outcomes,2018, 4(1):51-58. [6] WILLIAMS N. The MRC breathlessness scale[J].Occup Med (Lond),2017, 67(6):496-497. [7] PANG P S, BERGER D A, MAHLER S A, et al. Short-stay units vs routine admission from the emergency department in patients with acute heart failure: the SSU-AHF randomized clinical trial[J].JAMA Netw Open,2024, 7(1):e2350511. [8] 郭艳莉,刘萍. 心电图QRS波时限及QTc与急性左心衰竭患者院内临床转归的相关性[J].医学临床研究, 2023,40(10):1536-1539. [9] VOORS A A, DAMMAN K, BELDHUIS I E, et al. Discharge medication after natriuresis-guided dosing of diuretic therapy in patients hospitalized for acute heart failure: a PUSH-AHF substudy[J].JACC Heart Fail,2025, 13(1):179-181. [10] 中国医疗保健国际交流促进会急诊医学分会,中华医学会急诊医学分会,中国医师协会急诊医师分会,等. 急性心力衰竭中国急诊管理指南(2022)[J].中华急诊医学杂志,2022,31(8):1016-1041. [11] 邹长虹,张健. 2023年ESC关于2021年ESC急性和慢性心力衰竭诊断和治疗指南的重点更新解读[J].中华心血管病杂志, 2023, 51(12):1268-1272. [12] ASAKAGE A, BAEKGAARD J, DENIAU B, et al. Post-discharge therapies in AHF: a new STRONG (HF) piece of the puzzle[J].Heart Fail J India,2023, 1(1):12-15. [13] MEKAHLI D, GUAY-WOODFORD L M, CADNAPAPHORNCHAI M A, et al. Tolvaptan for children and adolescents with autosomal dominant polycystic kidney disease: randomized controlled trial[J].Clin J Am Soc Nephrol,2023, 18(1):36-46. [14] MINH N G, HOANG H N, MAEDA D, et al. Tolvaptan add-on therapy to overcome loop diuretic resistance in acute heart failure with renal dysfunction (DR-AHF):design and rationale[J].Front Cardiovasc Med,2022, 8: 783181. [15] PAN Y J, LI H, GAO J Y, et al. Tolvaptan for water retention in heart failure: a systematic review[J].Syst Rev,2023, 12(1):130.
2026, Vol. 43 
