Alterations in the autonomic and haemodynamic response to prolonged high-intensity endurance exercise in individuals with coronary artery calcification.
Jakob Svane, Tomasz Wiktorski, Trygve Eftestøl, Stein Ørn
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引用次数: 0
Abstract
Endurance exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of adverse cardiac events during exercise. The mechanisms underlying the development of CAC during prolonged high-intensity endurance exercise are unknown. This study aims to determine if there are differences in cardiovascular haemodynamic measures and heart rate variability (HRV) in individuals with (CAC+) and without CAC (CAC-). Hemodynamic measures from 56 healthy, middle-aged (median [interquartile range] 51 [43-58] years) individuals (41 men/15 women) participating in a 91 km [251.2 [217.2-271.6] min] leisure sport mountain bike race were included in this study. Twenty-five participants (20 men/5 women) were classified as CAC+ based on coronary computed tomographic assessment. Haemodynamic measures and HRV were quantified at the top of the hardest hill (THH) during the last quarter of the race. At the top of THH, CAC+ individuals had significantly higher systolic blood pressure (SBP) (235 [225-245] mmHg vs. 220 [193-238] mmHg, P = 0.008), higher diastolic blood pressure (DBP) (105 [95-110] mmHg vs. 95 [85-110] mmHg, P = 0.006), higher pulse pressure (130 [125-140] mmHg vs. 123 [110-130] mmHg, P = 0.039), higher mean rate pressure product (33,882 [30,872-35,053] bpm × mmHg vs. 31,028 [27,392-33,047] bpm × mmHg, P = 0.028), and larger increase in DBP from baseline (20 [20-30] mmHg vs. 10 [0-20] mmHg, P = 0.001), compared with CAC- individuals. Further, CAC+ participants showed a significant reduction in the low-frequency component of HRV (HRVLF) (6.3 [2.4-11.5] ms2 vs. 12.4 [6.8-20.2] ms2, P = 0.044). In multivariable analysis, HRVLF was an independent predictor of the presence of CAC even after adjusting for established risk factors of atherosclerosis: age, sex, body mass index, maximum heart rate, , smoking, resting SBP and resting DBP. CAC+ individuals had significant alterations in haemodynamic measures and HRVLF following prolonged high-intensity endurance exercise compared with individuals without CAC. HRVLF was an independent predictor of CAC, suggesting an adverse autonomic response to high-intensity endurance exercise in individuals with CAC.
耐力运动与延长寿命和改善生活质量有关。矛盾的是，高运动强度也与冠状动脉钙化（CAC）增加和运动期间不良心脏事件的风险虽小但显著增加有关。在长时间高强度耐力运动中CAC发生的机制尚不清楚。本研究旨在确定（CAC+）和（CAC-）患者的心血管血流动力学指标和心率变异性（HRV）是否存在差异。本研究纳入了参加91公里[251.2[217.2-271.6]分钟]休闲运动山地车比赛的56名健康中年人（中位数[四分位数间距]51[43-58]岁）（41名男性/15名女性）的血液动力学测量。25名参与者（20名男性/5名女性）根据冠状动脉计算机断层扫描评估被分类为CAC+。在最后四分之一的比赛中，在最硬的山顶（THH）测量血流动力学测量和HRV。在THH的顶部，CAC+个体的收缩压（SBP）显著升高（235 [225-245]mmHg vs. 220 [193-238] mmHg, P = 0.008），舒张压（DBP）升高（105 [95-110]mmHg vs. 95 [85-110] mmHg, P = 0.006），脉压升高（130 [125-140]mmHg vs. 123 [110-130] mmHg, P = 0.039），平均率压产物升高（33,882 [30,872-35,053]bpm × mmHg vs. 31,028 [27,392-33,047] bpm × mmHg, P = 0.028）。与CAC-个体相比，DBP较基线增加更大（20 [20-30]mmHg vs. 10 [0-20] mmHg, P = 0.001）。此外，CAC+参与者HRV （HRVLF）的低频成分显著降低（6.3 [2.4-11.5]ms2 vs. 12.4 [6.8-20.2] ms2, P = 0.044）。在多变量分析中，HRVLF是CAC存在的独立预测因子，即使调整了动脉粥样硬化的已知危险因素：年龄、性别、体重指数、最大心率、V / O / max ${{\dot{V}}_{{{{\ mathm {O}}} {\ mathm {max}}}}$、吸烟、静息收缩压和静息舒压。与没有CAC的个体相比，CAC+个体在长时间高强度耐力运动后的血流动力学测量和HRVLF有显著改变。HRVLF是CAC的独立预测因子，提示CAC患者对高强度耐力运动有不良的自主神经反应。
期刊介绍：
Experimental Physiology publishes research papers that report novel insights into homeostatic and adaptive responses in health, as well as those that further our understanding of pathophysiological mechanisms in disease. We encourage papers that embrace the journal’s orientation of translation and integration, including studies of the adaptive responses to exercise, acute and chronic environmental stressors, growth and aging, and diseases where integrative homeostatic mechanisms play a key role in the response to and evolution of the disease process. Examples of such diseases include hypertension, heart failure, hypoxic lung disease, endocrine and neurological disorders. We are also keen to publish research that has a translational aspect or clinical application. Comparative physiology work that can be applied to aid the understanding human physiology is also encouraged.
Manuscripts that report the use of bioinformatic, genomic, molecular, proteomic and cellular techniques to provide novel insights into integrative physiological and pathophysiological mechanisms are welcomed.
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