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https://www.arca.fiocruz.br/handle/icict/38877
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ArticleCopyright
Open access
Embargo date
2020-12-27
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- INI - Artigos de Periódicos [3394]
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CHOLINERGIC STIMULATION IMPROVES AUTONOMIC AND HEMODYNAMIC PROFILE DURING DYNAMIC EXERCISE IN PATIENTS WITH HEART FAILURE
Author
Affilliation
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil / Rio de Janeiro Federal University. Division of Cardiology. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil.
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil.
Rio de Janeiro Federal University. Division of Cardiology. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil.
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil.
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil.
Rio de Janeiro Federal University. Division of Cardiology. Rio de Janeiro, RJ, Brazil.
Fluminense Federal University. Department of Physiology and Pharmacology. Niterói, RJ, Brazil / Fluminense Federal University. Post-Graduate Program in Cardiovascular Sciences. Niterói, RJ, Brazil.
Abstract
Background: Parasympathetic dysfunction is an independent risk factor for mortality in heart failure for which there is no specific pharmacologic treatment. This article aims to determine the effect of pyridostigmine, an anticholinesterase agent, on the integrated physiologic responses to dynamic exercise in heart failure. Methods and Results: Patients with chronic heart failure (n = 23; 9 female; age= 48 +/-12 years) were submitted to 3 maximal cardiopulmonary exercise tests on treadmill in different days. The first test was used for adaptation and to determine exercise tolerance. The other tests were performed after oral administration of pyridostigmine (45 mg, 3 times/day, for 24 hours) or placebo, in random order. All patients were taking their usual medication. Pyridostigmine reduced cholinesterase activity by 30%, inhibitedthe chronotropic response throughout exercise, up to 60% of maximal effort (pyridostigmine510863 beats/min vs. placebo = 113 +/- 3 beats/min; P = .040), and improved heart rate reserve (pyridostigmine = 73 +/- 5 beats/min vs. placebo = 69 +/- 5 beats/min; P = 0.035) and heart rate recovery in the first minute after exercise (pyridostigmine = 25 +/- 2 beats/min vs. placebo = 22 +/- 2 beats/min; P = .005), whereas peak heart rate was similar to placebo. Oxygen pulse, an indirect indicator of stroke volume, was higher under pyridostigmine during submaximal exercise. Conclusions: Pyridostigmine was well tolerated by heart failure patients, leading to improved hemoynamic profile during dynamic exercise.
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