This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sato, H. Articles by Kamada, T. Search for Related Content PubMed PubMed Citation Articles by Sato, H. Articles by Kamada, T.

Circulation, Vol 88, 2215-2223, Copyright © 1993 by American Heart Association

ARTICLES

Exercise-induced upward shift of diastolic left ventricular pressure- volume relation in patients with dilated cardiomyopathy. Effects of beta-adrenoceptor blockade

H Sato, M Hori, H Ozaki, H Yokoyama, K Imai, M Morikawa, H Takeda, M Inoue and T Kamada
First Department of Medicine, Osaka University School of Medicine, Japan.

BACKGROUND. The effectiveness of beta-blocker therapy for dilated cardiomyopathy (DCM) may be attributed to the inhibition of detrimental effects on the failing heart of sympathetic stimulation during exertion. However, the harmful effects of activity as well as the protective effects of beta-blockers have not been demonstrated. Diastolic ventricular function is known to be sensitive to transient myocardial metabolic insult. In this study, we investigated the effect of modest exercise with or without beta-blockade on the diastolic left ventricular pressure-volume (P-V) relation in patients with DCM. METHODS AND RESULTS. The diastolic left ventricular P-V relation was obtained by high-fidelity pressure measurements and digital subtraction left ventriculography at rest and immediately after modest supine bicycle exercise in 12 patients with DCM. The effects of intravenous administration of 0.1 mg/kg propranolol on resting and exercise P-V relations were studied. The end-diastolic and lowest left ventricular pressures were significantly elevated by exercise (20 +/- 9 to 32 +/- 13 mm Hg, P < .01, and 12 +/- 6 to 21 +/- 11 mm Hg, P < .01, respectively) despite insignificant changes in left ventricular volumes. The administration of propranolol did not alter the resting diastolic P-V relation. However, propranolol significantly attenuated the exercise-induced upward shift of the diastolic P-V relation despite a significant increase in end-diastolic volume. The significant upward shift and attenuation by propranolol were also observed even when the left ventricular pressure was corrected by the subtraction of right atrial pressure. CONCLUSIONS. These results indicate that even modest exercise exerts detrimental effects on diastolic left ventricular function of the failing heart through beta-adrenergic stimulation. The clinical effectiveness of beta-blocker therapy in patients with DCM can be attributed in part to the inhibition of detrimental myocardial effects of sympathetic stimulation during daily activity.

This article has been cited by other articles:

				S. Kasama, T. Toyama, H. Kumakura, Y. Takayama, S. Ichikawa, T. Suzuki, and M. Kurabayashi Spironolactone Improves Cardiac Sympathetic Nerve Activity and Symptoms in Patients with Congestive Heart Failure J. Nucl. Med., October 1, 2002; 43(10): 1279 - 1285. [Abstract] [Full Text] [PDF]

				S. Kasama, T. Toyama, H. Hoshizaki, S. Oshima, K. Taniguchi, T. Suzuki, and M. Kurabayashi Dobutamine Gated Blood Pool Scintigraphy Predicts the Improvement of Cardiac Sympathetic Nerve Activity, Cardiac Function, and Symptoms After Treatment in Patients With Dilated Cardiomyopathy* Chest, August 1, 2002; 122(2): 542 - 548. [Abstract] [Full Text] [PDF]

				C.-P. Cheng, T. Ukai, K. Onishi, N. Ohte, M. Suzuki, Z.-S. Zhang, H.-J. Cheng, H. Tachibana, A. Igawa, and W. C. Little The role of ANG II and endothelin-1 in exercise-induced diastolic dysfunction in heart failure Am J Physiol Heart Circ Physiol, April 1, 2001; 280(4): H1853 - H1860. [Abstract] [Full Text] [PDF]

				M Morikawa, H Sato, H Sato, Y Koretsune, Y Ohnishi, T Kurotobi, T Kuzuya, and M Hori Sustained left ventricular diastolic dysfunction after exercise in patients with dilated cardiomyopathy Heart, September 1, 1998; 80(3): 263 - 269. [Abstract] [Full Text]

				B. D. Prendergast, B M. Sci, V. F. Sagach, and A. M. Shah Basal Release of Nitric Oxide Augments the Frank-Starling Response in the Isolated Heart Circulation, August 19, 1997; 96(4): 1320 - 1329. [Abstract] [Full Text]

				Effects of Carvedilol, a Vasodilator–ß-Blocker, in Patients With Congestive Heart Failure Due to Ischemic Heart Disease Circulation, July 15, 1995; 92(2): 212 - 218. [Abstract] [Full Text]