Impaired Chronotropic Response to Exercise in Acute Myocardial Infarction Patients with Type 2 Diabetes Mellitus.

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概要

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• This study was undertaken in acute myocardial infarction (AMI) patients with non-insulin-dependent diabetes mellitus (type 2 DM) to investigate their impaired chronotropic response to exercise. Seventy-one AMI subjects entered the study, 30 with type 2 DM and 41 age- and body mass index-matched non-DM (control) patients. One month after the onset of AMI, these patients underwent cardiopulmonary exercise testing on a treadmill under a ramp protocol. Anaerobic threshold (AT) and peak oxygen uptake (peak VO2) were determined as indicators of exercise capacity. Plasma norepinephrine (NE) concentration was measured in blood samples obtained at 2 time points: during pre-exercise rest and immediately after peak exercise. The change in NE concentration during exercise, as an index of sympathetic nervous activity, was calculated as a percentage: ΔNE = [(NE during exercise) - (resting value)]/(resting value) × 100. The change in heart rate (HR) during exercise was calculated as a simple difference: ΔHR = [(peak HR) - (rest HR)]. Index of chronotropic response to exercise was then quantified as the ΔHR/ ΔNE during exercise. No significant intergroup differences in ejection fraction at rest or HR at peak exercise were observed. However, VO2 at AT, peak VO2, ΔHR, and ΔHR/ΔNE were significantly lower in the type 2 DM group than in the non-DM group. ΔHR correlated with VO2 at AT (r = 0.49, P < 0.001) and with peak VO2 (r = 0.53, P < 0.001) in all subjects. Also, ΔHR/ ΔNE correlated with VO2 at AT (r = 0.42, P < 0.001) and with peak VO2 (r = 0.44, P < 0.001) in all subjects. AMI patients with type 2 DM had impaired cardiopulmonary responses to maximal and submaximal exercise testing and impaired chronotropic response to exercise, even though their cardiac function at rest was similar to that of non-DM AMI patients. The data suggest that one mechanism of impaired cardiopulmonary response to exercise in AMI patients with type 2 DM groups is an impaired chronotropic response.

• International Heart Journal刊行会の論文

著者

• Osada Naohiko

  Division Of Cardiology Department Of Internal Medicine St Marianna University School Of Medicine

• Yokoyama Yasuhiro

  Division Of Cardiology Department Of Internal Medicine St Marianna University School Of Medicine

• Izawa Kazuhiro

  Department Of Rehabilitation Medicine St. Marianna University Hospital

• Omiya Kazuto

  Division Of Cardiology Department Of Internal Medicine St. Marianna University School Of Medicine

• Tanabe Kazuhiko

  Division Of Cardiology Department Of Internal Medicine St. Marianna University School Of Medicine

• Kasahara Yusuke

  Department of Rehabilitation Medicine, St. Marianna University School of Medicine Yokohama City Seib

• Murayama Masahiro

  Division Of Cardiology Department Of Internal Medicine St Marianna University School Of Medicine

• Yamada Sumio

  Department Of Physical Therapy Nagoya University School Of Health Sciences

• Ishiguro Tomoyasu

  Department Of Rehabilitation Medicine St. Marianna University School Of Medicine Toyoko Hospital

• Hirano Yasuyuki

  Department Of Mathematics Faculty Of Science Okayama University

• Miyake Fumihiko

  Division Of Cardiology Department Of Internal Medicine St Marianna University School Of Medicine

• Osada Naohiko

  Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine

• Yagi Maiko

  Department of Rehabilitation Medicine, St. Marianna University School of Medicine

• Izawa Kazuhiro

  Department of Rehabilitation Medicine, St. Marianna University School of Medicine

• Kasahara Yusuke

  Department of Rehabilitation Medicine, St. Marianna University School of Medicine

• Murayama Masahiro

  Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine

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