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(Circulation. 1997;96:2959-2968.)
© 1997 American Heart Association, Inc.
Articles |
Adrenergic Control of the Force-Frequency and Relaxation-Frequency Relations in Patients With Hypertrophic Cardiomyopathy
From the First Department of Internal Medicine (H.I., Y.T., M.I., K.N., M.I., T.S.) and the Department of Clinical Laboratory Medicine (M.Y.), Nagoya (Japan) University School of Medicine.
Correspondence to Mitsuhiro Yokota, MD, PhD, Cardiovascular Section, Department of Clinical Laboratory Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466 Japan. E-mail myokota{at}tsuru.med.nagoya-u.ac.jp
Background Exercise-induced enhancement of the force-frequency and relaxation-frequency relations has been studied in conscious animals but not in intact diseased human hearts.
Methods and Results We evaluated left
ventricular (LV) isovolumic contraction
(dP/dtmax) and relaxation (
) during atrial pacing and
dynamic exercise in 13 patients with nonobstructive hypertrophic
cardiomyopathy (HCM) and 7 control subjects to
investigate the influence of exercise on the force-frequency and
relaxation-frequency relations. Group A consisted of 6 patients in whom
the heart rate (HR)–dP/dtmax relation was markedly
enhanced during exercise (88±30%) compared with during pacing
(34±15%). Group B consisted of 7 patients in whom the
HR-dP/dtmax relation showed similar enhancement during
exercise (28±7%) and atrial pacing (28±11%). There was no
difference in the HR- (derivative method [TD] and pressure
half-time method [T1/2]) relation between pacing and
exercise in groups A and B. Both the mean maximal wall thickness and
the hypertrophy score in group B were greater than in group
A (27±5 versus 19±2 mm and 7±1 versus 5±1 points,
respectively; both P<.01). There was no difference in the
LV peak systolic pressure, end-diastolic pressure,
or the plasma level of catecholamines at baseline, at 50 W
of exercise, and at peak pacing between groups A and B. The
HR-dP/dtmax relation in the control group was markedly
enhanced during exercise (80±27%) compared with during pacing
(32±14%). The HR- relation in the control group was enhanced
during exercise (TD, 35±9%; T1/2, 34±8%) compared with
during pacing (TD, 12±7%; T1/2, 14±7%).
Conclusions Exercise-induced enhancement of the relaxation-frequency relation was inhibited in all HCM patients, regardless of the degree of LV hypertrophy. The patients without exercise-induced enhancement of the force-frequency relation had more severe LV hypertrophy than the patients with the enhancement, indicating that the adrenergic control of the force-frequency relation may, at least in part, depend on the severity of LV hypertrophy or the stage of HCM.
Key Words: cardiomyopathy • exercise • contractility
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