BLUNTED CARDIAC RESPONSES TO EXERCISE-INDUCED SYMPATHETIC STIMULATION IN NON-FAILING AORTIC REGURGITATION : INSIGHT INTO ROLE OF CARDIAC DILATATION IN HYPORESPONSE OF FAILING HEARTS

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• Although blunted cardiac response to sympathetic stimulation in patients with heart failure is usually attributed to myocardial beta_1-adrenoceptor downregulation secondary to elevated circulating catecholamines, cardiomegaly per se may also play a role through presynaptic mechanisms such as reduction in cardiac norepinephrine (NE) concentration. To evaluate effects of cardiac dilatation on cardiac response to sympathetic stimulation, we studied left ventricular contractile and heart rate responses to plasma NE levels increased by exercise in 10 asymptomatic patients with a dilated left ventricle due to aotric regurgitation (AR), but with normal resting plasma NE levels, using 10 normal subjects and 10 patients with heart failure due to dilated cardiomyopathy (DCM) as controls. Plasma NE levels, systemic blood pressure, echocardiograph left ventricular dimensions, and heart rate were measured at rest, and at 3 submaximal levels of supine bicycle exercise. The ratio of peak systolic blood pressure to end-systolic dimension (P/D ratio), heart rate, and plasma NE increased with the intensity of exercise. In each subject, both P/D ratio and heart rate increased in a logarithmic manner against plasma NE levels. The solpe of the regression line for log (plasma NE)-P/D ratio relation, and that for log (plasma NE)-heart rate relation, were significantly less in patients with AR than in normal subjects (p<0.001 and p<0.05, respectively), and were less in patients with DCM than in patients with AR (p<0.005 and p=0.051, respectively). Thus, the left ventricular contractile and heart rate responses to sympathetic stimulation are blunted in patients with dilated hearts due to AR, even in the absence of overt heart failure and elevated plasma NE levels. These responses were further de-creased in patients with heart failure due to DCM. Cardiac responses to sym-

• 社団法人日本循環器学会の論文
• 1992-02-20

著者

• Suga H

  Department Of Cardiovascular Medicine Osaka University Graduate School Of Medicine

• Horio Masaru

  Ehime University

• Imai Katsuji

  Cardiovascular Center Sakurabashi Watanabe Hospital

• Kamada Takenobu

  The First Department Of Medicine And The Department Of Medical Information Science

• Kitabatake Akira

  The First Department Of Medicine Osaka University School Of Medicine

• Kitabatake Akira

  From The Division Of Cardiology First Department Of Medicine And The Department Of Pathophysiology O

• Ishida Yoshio

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of M

• Kitabatake A

  Hokkaido Univ. Sapporo Jpn

• KITABATAKE Akira

  First Department of Medicine, Osaka University School of Medicine

• KAMADA Takenobu

  First Department of Medicine, Osaka University School of Medicine

• Masuyama Tohru

  兵庫医科大学 循環器内科

• Inui Makoto

  First Department Of Medicine And Department Of Pathophysiology Osaka University School Of Medicine

• Inoue M

  Division Of Cardiology Osaka National Hospital

• Ozaki Hitoshi

  The First Department of Medicine and the Department of Medical Information Science

• MATSUYAMA TAIZO

  First Department of Medicine and Faculty of Medical Information Science, Osaka University School of

• SATO HIDEYUKI

  First Department of Medicine and Faculty of Medical Information Science, Osaka University School of

• OZAKI HITOSHI

  First Department of Medicine and Faculty of Medical Information Science, Osaka University School of

• IMAI KATSUJI

  First Department of Medicine and Faculty of Medical Information Science, Osaka University School of

• H0RI MASATSUGU

  First Department of Medicine and Faculty of Medical Information Science, Osaka University School of

• IN0UE MICHITOSHI

  First Department of Medicine and Faculty of Medical Information Science, Osaka University School of

• Arai Kazutaka

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of M

• Ishida Yoshio

  First Dep't Of Medicine Osaka University Medical School

• Inoue Michitoshi

  Osaka University School Of Medicine

• Inoue Michitoshi

  The First Department Of Medicine Osaka University Medical School

• Kamada Takenobu

  1st Dept. Of Med. Medical School Osaka University

• Ishida Yoshio

  1st. Dept. Of Medicine Osaka University Medical School

• Kitabatake Akira

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of M

• Kamada Takenobu

  First Department Of Internal Medicine Osaka University School Of Medicine

• Inoue Michitoshi

  First Department Of Medicine And Department Of Pathophysiology Osaka University School Of Medicine

• Inoue M

  Osaka National Hospital

• Ishida Yoshio

  The First Department Of Medicine Osaka University School Of Medicine

• Kitabatake Akira

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of M

• Ishida Yoshio

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of M

• Ishida Yoshio

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of M

• Kitabatake Akira

  First Department Of Medicine And Faculty Of Medical Information Science Osaka University School Of Medicine

• Kitabatake A

  Department Of Cardiovascular Medicine Hokkaido University Graduate School Of Medicine

• Arai Kazutaka

  From The Division Of Cardiology First Department Of Medicine And The Department Of Pathophysiology Osaka University School Of Medicine

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