Francis G S, Goldsmith S R, Ziesche S, Nakajima H, Cohn J N
J Am Coll Cardiol. 1985 Apr;5(4):832-9. doi: 10.1016/s0735-1097(85)80420-4.
Patients with congestive heart failure have been considered to have augmented sympathetic drive both at rest and during dynamic exercise. The augmentation observed during exercise may be related to the state of near exhaustion experienced by patients with heart failure at relatively low work loads. To compare the response of the sympathetic nervous system to exercise in normal subjects and patients with heart failure when they are working in a comparable physiologic frame of reference, the data for both groups can be expressed as percent peak oxygen consumption achieved (percent peak VO2) rather than as a function of absolute oxygen consumption (VO2). Ten healthy control subjects and 31 patients with chronic clinical class II and III heart failure were studied during upright maximal bicycle exercise. Eighteen of the 31 patients had primary cardiomyopathy and 13 had ischemic cardiomyopathy. The average ejection fraction at rest was 24 +/- 10% (+/- SD) in the group with heart failure. Heart rate, systolic blood pressure, VO2 and plasma norepinephrine levels were measured at rest and throughout exercise. When the data were expressed as a function of percent peak VO2 achieved, patients with heart failure demonstrated a flatter slope (p = 0.004) than normal in the response of plasma norepinephrine to exercise, indicating a relative blunting of sympathetic drive. This was accompanied by attenuated heart rate (p = 0.001) and blood pressure (p less than 0.001) responses. These differences were not apparent when the data are expressed as a function of absolute VO2.(ABSTRACT TRUNCATED AT 250 WORDS)
充血性心力衰竭患者在静息和动态运动时均被认为交感神经驱动增强。运动时观察到的这种增强可能与心力衰竭患者在相对低工作负荷下所经历的接近疲惫状态有关。为了比较正常受试者和心力衰竭患者在处于可比生理参照系下运动时交感神经系统的反应，两组数据可以表示为达到的峰值耗氧量百分比（峰值VO₂百分比），而非绝对耗氧量（VO₂）的函数。对10名健康对照受试者和31名慢性临床II级和III级心力衰竭患者进行了直立位最大自行车运动研究。31名患者中有18名患有原发性心肌病，13名患有缺血性心肌病。心力衰竭组静息时的平均射血分数为24±10%（±标准差）。在静息和整个运动过程中测量心率、收缩压、VO₂和血浆去甲肾上腺素水平。当数据表示为达到的峰值VO₂百分比的函数时，心力衰竭患者血浆去甲肾上腺素对运动的反应斜率比正常受试者更平缓（p = 0.004），表明交感神经驱动相对减弱。这伴随着心率（p = 0.001）和血压（p < 0.001）反应减弱。当数据表示为绝对VO₂的函数时，这些差异并不明显。（摘要截短于250字）
