Miętkiewska-Szwacka Kamila, Krauze Tomasz, Barecka Katarzyna, Różańska-Kirschke Anna, Przymuszała-Staszak Dagmara, Schneider Agata, Dziarmaga Miłosz, Tarchalski Jacek Lech, Nowak Aneta, Bryl Mateusz, Kaczmarek Jolanta, Piskorski Jarosław, Wykrętowicz Andrzej, Guzik Przemysław
Department of Internal Medicine, Metabolic Disorders, and Hypertension, Poznan University of Medical Sciences, 60-786 Poznan, Poland.
Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, 60-355 Poznan, Poland.
J Clin Med. 2023 Jan 28;12(3):1007. doi: 10.3390/jcm12031007.
Aldosterone regulates hemodynamics, including blood pressure (BP), and is involved in the development and progression of cardiovascular diseases, including systolic heart failure (HF). While exercise intolerance is typical for HF, neither BP nor heart rate (HR) have specific characteristics in HF patients. This study compares BP and HR profiles during and after standardized exercise between patients with systolic HF with either lower or higher aldosterone concentrations. We measured BP and HR in 306 ambulatory adults with systolic HF (left ventricular ejection fraction (LVEF) <50%) during and after a 6 min walk test (6MWT). All patients underwent a resting transthoracic echocardiography, and venous blood samples were collected for biochemical analyses. The patients were also divided into tertiles of serum aldosterone concentration: T1 (<106 pg/mL), T2 (106 and 263 pg/mL) and T3 (>263 pg/mL), respectively. Individuals from T1 and T2 were combined into T1-T2 as the reference group for comparisons with patients from T3. The individuals from T3 had significantly lower systolic, mean and diastolic BPs at rest, at the end and at 1 and 3 min post-6MWT recovery, as well as a more dilated left atrium and right ventricle alongside a higher concentration of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Higher serum aldosterone concentration in HF patients with an LVEF < 50% is associated with a lower 6MWT BP but not an HR profile.
醛固酮调节包括血压（BP）在内的血流动力学，并参与包括收缩性心力衰竭（HF）在内的心血管疾病的发生和发展。虽然运动不耐受是HF的典型症状，但HF患者的血压和心率（HR）均无特异性特征。本研究比较了醛固酮浓度较低或较高的收缩性HF患者在标准化运动期间及之后的血压和心率情况。我们在306例门诊收缩性HF成人患者（左心室射血分数（LVEF）<50%）进行6分钟步行试验（6MWT）期间及之后测量了血压和心率。所有患者均接受了静息经胸超声心动图检查，并采集静脉血样进行生化分析。患者还根据血清醛固酮浓度分为三分位数：T1（<106 pg/mL）、T2（106至263 pg/mL）和T3（>263 pg/mL）。将T1和T2的个体合并为T1-T2作为参考组，与T3组患者进行比较。T3组个体在静息时、6MWT结束时以及恢复后1分钟和3分钟时的收缩压、平均压和舒张压均显著较低，同时左心房和右心室更扩张，N末端B型利钠肽原（NT-proBNP）浓度更高。LVEF<50%的HF患者血清醛固酮浓度较高与6MWT血压较低相关，但与心率情况无关。
