Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Respir Med. 2024 Nov;233:107775. doi: 10.1016/j.rmed.2024.107775. Epub 2024 Aug 13.
Invasive cardiopulmonary exercise testing (iCPET) combines traditional cardiopulmonary exercise testing with invasive hemodynamic measurements to assess exercise intolerance, which can be caused by preload insufficiency (PI), characterized by low ventricular filling pressures and reduced cardiac output during exertion. We hypothesize that plasma catecholamine levels at rest and during exercise correlate with hemodynamic parameters in PI.
We included adult patients who underwent iCPET for exercise intolerance and had plasma catecholamines measured at rest and peak exercise.
Among 84 patients, PI was identified in 57 (67.8 %). Compared to patients without PI, those with PI were younger [median (IQR) 37 (28, 46) vs 47 (39,55) years, p = 0.005] and had lower workload at peak exercise [81 (66, 96) vs 95 (83.5, 110.50) Watts, p = 0.006]. Patients with PI had higher heart rates at rest and peak exercise [87 (78, 97) vs 79 (74, 87) bpm, p = 0.04; and 167 (154, 183) vs 156 (136, 168) bpm, p = 0.01, respectively]. In all patients, epinephrine and norepinephrine at peak exercise directly correlated with peak workload (r:0.41, p < 0.001 and r:0.47, p < 0.001, respectively). Resting epinephrine was higher in patients with PI [136 (60, 210) vs 77 (41, 110) pg/mL, p = 0.02]. There was no significant difference in the change in catecholamines from rest to peak exercise between patients with or without PI.
PI patients exhibited elevated heart rate and epinephrine at rest, indicating increased sympathetic activity. We did not find strong associations between catecholamines and cardiac filling pressures, suggesting that catecholamine levels are predominantly influenced by peak workload.
侵入性心肺运动测试（iCPET）将传统心肺运动测试与侵入性血流动力学测量相结合，以评估运动不耐受，这可能是由前负荷不足（PI）引起的，其特征是在用力时心室充盈压低和心输出量减少。我们假设静息和运动时的血浆儿茶酚胺水平与 PI 中的血流动力学参数相关。
我们纳入了因运动不耐受而行 iCPET 检查且在静息和峰值运动时测量了血浆儿茶酚胺的成年患者。
在 84 例患者中，有 57 例（67.8%）存在 PI。与无 PI 患者相比，PI 患者更年轻[中位数（IQR）37（28，46）岁比 47（39.55，55）岁，p=0.005]，峰值运动时的工作负荷较低[81（66，96）比 95（83.5，110.50）瓦特，p=0.006]。PI 患者在静息和峰值运动时的心率更高[87（78，97）比 79（74，87）次/分，p=0.04；167（154，183）比 156（136，168）次/分，p=0.01，分别]。在所有患者中，峰值运动时的肾上腺素和去甲肾上腺素与峰值工作负荷直接相关（r：0.41，p<0.001 和 r：0.47，p<0.001）。PI 患者的静息肾上腺素水平更高[136（60，210）比 77（41，110）pg/ml，p=0.02]。PI 患者与无 PI 患者相比，儿茶酚胺从静息到峰值运动的变化无显著差异。
PI 患者在静息时表现出较高的心率和肾上腺素水平，表明交感神经活动增加。我们没有发现儿茶酚胺与心脏充盈压之间有很强的关联，这表明儿茶酚胺水平主要受峰值工作负荷的影响。
