Chest ACCP Education Calendar
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kinugawa, T.
Right arrow Articles by Shigemasa, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kinugawa, T.
Right arrow Articles by Shigemasa, C.
(Chest. 1998;114:1295-1300.)
© 1998 American College of Chest Physicians

Sympathetic Nervous Response Relative to the Adenosine Triphosphate Supply-Demand Imbalance During Exercise Is Augmented in Patients With Heart Failure

Toru Kinugawa MD, PhD1; Kazuhide Ogino MD, PhD1; Noriyasu Noguchi MD, PhD1; Masatake Mori MD, PhD1; Hiroyuki Miyakoda MD, PhD1; Ichiro Hisatome MD, PhD1; and Chiaki Shigemasa MD, PhD1

1 From the First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan

Torn Kinugawa, MD, PhD, The 1st Department of Internal Medicine, Tottori University School of Medicine, 36-1 Nishimachi, Yonago, 683, Japan; e-mail: kinugawa{at}grape.med.tottori-u.ac.jp

Objective: Increase in plasma hypoxanthine (HX) (purine nucleotide degradation product from working muscle) reflects insufficiency of adenosine triphosphate (ATP) supply during exercise, and the exercise-induced increase in plasma norepinephrine (NE) can be an index of sympathetic nerve activity. The aim of this study was to investigate the relationship between plasma NE and plasma HX during exercise in patients with heart failure (HF) according to its severity.

Methods: Blood lactate, plasma HX, and plasma NE were measured at rest and after symptom-limited cardiopulmonary exercise test in 54 patients with HF (New York Heart Association [NYHA] classes I:18, II:20, III:16) and 19 normal subjects.

Results: Peak work rate and peak oxygen uptake decreased as the NYHA functional class increased. Blood lactate and plasma HX levels at rest were comparable, but peak blood lactate (normal, NYHA I, II, III: 6.4 ± 0.3, 5.6 ± 0.4, 5.3 ± 0.3, 3.5 ± 0.2 mmol/L) and peak plasma HX (3.6 ± 0.4, 3.0 ± 0.5, 2.4 ± 0.3, 1.4 ± 0.1 p, µmol/L) were progressively smaller as HF worsened. Resting plasma NE (137 ± 15, 180 ± 29, 201 ± 21, 318 ± 55 pg/mL) was significantly higher in NYHA class III HF, but peak plasma NE (2,235 ± 356, 2,021 ± 326, 2,188 ± 292, 2,210 ± 316 pg/mL) was not different among groups. The ratio of the exercise increments in plasma NE to the increments in plasma HX during exercise (Dgrplasma NE/Dgrplasma HX: 666 ± 96, 1,083 ± 229, 1,252 ± 222, 2,260 ± 351) increased according to the severity of HF.

Conclusion: These data suggest that plasma levels of HX after maximal exercise are smaller as HF worsened, and sympathetic responsiveness to the imbalance of ATP supply-demand during exercise is augmented according to the severity of HF.

Key Words: exercise test • heart failure • hypoxanthine • norepinephrine • sympathetic nervous activity

Submitted on December 31, 1997
Accepted on June 9, 1998






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1998 by the American College of Chest Physicians.