Fraga Raffael, Franco Fábio G, Roveda Fabiana, de Matos Luciana N J, Braga Ana M F W, Rondon Maria U P B, Rotta Daniel R, Brum Patricia C, Barretto Antonio C P, Middlekauff Holly R, Negrão Carlos E
Heart Institute InCor, University of São Paulo, Medical School, São Paulo, Brazil.
Eur J Heart Fail. 2007 Jun-Jul;9(6-7):630-6. doi: 10.1016/j.ejheart.2007.03.003. Epub 2007 May 1.
Evidence suggests that carvedilol decreases muscle sympathetic nerve activity (MSNA) in patients with heart failure (HF) but carvedilol fails to improve forearm vascular resistance and overall functional capacity. Exercise training in HF reduces MSNA and improves forearm vascular resistance and functional capacity.
To investigate whether the beneficial effects exercise training on MSNA are maintained in the presence of carvedilol.
Twenty seven HF patients, NYHA Class II-III, EF <35%, peak VO(2) <20 ml/kg/min, treated with carvedilol were randomly divided into two groups: exercise training (n=15) and untrained (n=12). MSNA was recorded by microneurography. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. The four-month training program consisted of three 60-min exercise/week on a cycloergometer. Baseline parameters were similar between groups. Exercise training reduced MSNA (-14+/-3.3 bursts/100 HB, p=0.001) and increased forearm blood flow (0.6+/-0.1 mL/min/100 g, p<0.001) in HF patients on carvedilol. In addition, exercise training improved peak VO(2) in HF patients (20+/-6%, p=0.002). MSNA, FBF and peak VO(2) were unchanged in untrained HF patients on carvedilol.
Exercise training reduces MSNA in heart failure patients treated with carvedilol. In addition, the beneficial effects of exercise training on muscle blood flow and functional capacity are still realized in patients on carvedilol.
有证据表明，卡维地洛可降低心力衰竭（HF）患者的肌肉交感神经活动（MSNA），但卡维地洛未能改善前臂血管阻力和整体功能能力。HF患者进行运动训练可降低MSNA，并改善前臂血管阻力和功能能力。
研究在使用卡维地洛的情况下，运动训练对MSNA的有益作用是否得以维持。
27例接受卡维地洛治疗的NYHA II-III级、左心室射血分数（EF）<35%、峰值摄氧量（peak VO₂）<20 ml/kg/min的HF患者被随机分为两组：运动训练组（n = 15）和未训练组（n = 12）。通过微神经ography记录MSNA。通过静脉阻断体积描记法测量前臂血流量（FBF）。为期四个月的训练计划包括每周在测力计上进行三次60分钟的运动。两组之间的基线参数相似。运动训练降低了使用卡维地洛的HF患者的MSNA（-14±3.3次爆发/100次心跳，p = 0.001），并增加了前臂血流量（0.6±0.1 mL/min/100 g，p<0.001）。此外，运动训练改善了HF患者的peak VO₂（20±6%，p = 0.002）。使用卡维地洛的未训练HF患者的MSNA、FBF和peak VO₂未发生变化。
运动训练可降低接受卡维地洛治疗的心力衰竭患者的MSNA。此外，运动训练对肌肉血流量和功能能力的有益作用在使用卡维地洛的患者中仍然可以实现。
