Francis G S, Goldsmith S R, Ziesche S M, Cohn J N
Am J Cardiol. 1982 Apr 1;49(5):1152-6. doi: 10.1016/0002-9149(82)90039-x.
The activity of the sympathetic nervous system is increased at rest in patients with congestive heart failure. To determine whether this augmentation is carried over during dynamic upright exercise, 14 patients with congestive heart failure were stressed maximally during upright bicycle ergometry. Plasma norepinephrine and epinephrine levels were measured in the basal upright (sitting) posture before and during maximal exercise. The results were compared with those in six healthy control subjects before and during maximal exercise. Plasma norepinephrine increased during exercise from a mean (+/- standard error of the mean) of 650 +/- 95 to 1,721 +/- pg/ml in the group with heart failure. This increase was significantly less (p less than 0.001) than that in the control group (from 318 +/- 36 to 3,230 +/- 418 pg/ml). However, for equivalent levels of total body oxygen consumption (VO2), the group with heart failure had higher levels of plasma norepinephrine than the control group. Plasma epinephrine was similar in the two groups in the basal upright position (92 +/- 18 and 92 +/- 26 pg/ml), but it increased more during exercise in the normal subjects (743 +/- 210 pg/ml) than in the group with heart failure (167 +/- 67 pg/ml) (p less than 0.001). The percent increase in norepinephrine correlated with the percent change in VO2 in the group with heart failure (r = 0.62, p less than 0.02), but the percent change in epinephrine did not. There is, therefore, a disturbance in the sympathetic nervous system during exercise in patients with congestive heart failure. Although norepinephrine increases in such patients to a greater extent than in normal subjects at lower levels of exercise, the extremely high levels of norepinephrine and epinephrine generated by normal subjects during maximal upright exercise do not occur in patients with heart failure.
充血性心力衰竭患者在静息状态下交感神经系统活性增强。为了确定这种增强在动态直立运动期间是否持续存在，对14例充血性心力衰竭患者进行了直立自行车测力计最大负荷运动试验。在最大运动前和运动期间，测量了基础直立（坐姿）姿势下的血浆去甲肾上腺素和肾上腺素水平。将结果与6名健康对照者在最大运动前和运动期间的结果进行比较。心力衰竭组运动期间血浆去甲肾上腺素从平均（±平均标准误差）650±95 pg/ml增加至1721± pg/ml。这种增加显著低于对照组（从318±36 pg/ml增加至3230±418 pg/ml）（p<0.001）。然而，对于同等水平的全身耗氧量（VO2），心力衰竭组的血浆去甲肾上腺素水平高于对照组。两组在基础直立位时血浆肾上腺素水平相似（分别为92±18 pg/ml和92±26 pg/ml），但正常受试者运动期间的增加幅度（743±210 pg/ml）大于心力衰竭组（167±67 pg/ml）（p<0.001）。心力衰竭组去甲肾上腺素增加百分比与VO2变化百分比相关（r=0.62，p<0.02），但肾上腺素变化百分比无相关性。因此，充血性心力衰竭患者运动期间交感神经系统存在紊乱。虽然此类患者在较低运动水平时去甲肾上腺素的增加幅度大于正常受试者，但心力衰竭患者在最大直立运动期间不会出现正常受试者产生的极高水平的去甲肾上腺素和肾上腺素。
