Document Detail


Effects of cold exposure on submaximal exercise performance and adrenergic activation in patients with congestive heart failure and the effects of beta-adrenergic blockade (carvedilol or metoprolol).
MedLine Citation:
PMID:  12943875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with congestive heart failure (CHF) exhibit a decrease in maximal exercise capacity in response to a cold environment. The aim of this study was to further investigate the impact of cold exposure on submaximal exercise capacity, systemic adrenergic drive, and the effects of long-term beta-adrenergic blockade on these parameters. Thirty-three patients with CHF, with exercise limited by dyspnea and left ventricular ejection fraction of 26 +/- 4%, were randomized to receive metoprolol or carvedilol for 6 months. The observations were compared with 12 age-matched healthy volunteers. Maximal exercise performance with gas exchange analyses were assessed using a ramp protocol, and endurance capacity was measured using 2 constant-load exercise tests performed randomly at 20 degrees C and -8 degrees C. Healthy volunteers increased their submaximal exercise time by 20% (1,353 +/- 455 [20 degrees C] vs 1,635 +/- 475 seconds [-8 degrees C]; p <0.05), whereas patients with CHF exhibited a 21% decrease in exercise time (1,182 +/- 549 [20 degrees C] vs 931 +/- 524 seconds [-8 degrees C]; p <0.05) at -8 degrees C. Beta blockers increased submaximal exercise duration at 20 degrees C (+261 +/- 617 seconds; p <0.05) and -8 degrees C (+374 +/- 729 seconds; p <0.05). Norepinephrine increased to a greater extent at 4 minutes and at the time of exhaustion (at -8 degrees C) only in patients with CHF. Beta-adrenergic blockade caused no significant decrease in plasma norepinephrine levels. Patients with symptomatic CHF exhibited a significant decrease in submaximal exercise time in response to moderate cold exposure. Beta-blocker therapy with either metoprolol or carvedilol significantly increases submaximal exercise time and attenuates the impact of cold exposure on functional capacity.
Authors:
Martine Blanchet; Anique Ducharme; Normand Racine; Jean Lucien Rouleau; Jean Claude Tardif; Martin Juneau; Johanne Marquis; Lucie Larivée; Anil Nigam; Anick Fortier; Michel White
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  92     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-08-28     Completed Date:  2003-10-07     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  548-53     Citation Subset:  AIM; IM    
Affiliation:
Research Center, Montreal Heart Institute, Quebec, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / pharmacology,  therapeutic use*
Aged
Blood Gas Analysis
Carbazoles / pharmacology,  therapeutic use*
Case-Control Studies
Cold Temperature / adverse effects*
Dyspnea / etiology
Exercise Test / drug effects
Exercise Tolerance / drug effects*
Female
Heart Failure / complications,  drug therapy*,  metabolism,  physiopathology*
Humans
Male
Metoprolol / pharmacology,  therapeutic use*
Middle Aged
Norepinephrine / blood
Physical Endurance
Propanolamines / pharmacology,  therapeutic use*
Prospective Studies
Receptors, Adrenergic / drug effects*,  physiology*
Single-Blind Method
Stroke Volume / drug effects
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0/Receptors, Adrenergic; 37350-58-6/Metoprolol; 51-41-2/Norepinephrine; 72956-09-3/carvedilol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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