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Assessment of cardiac reserve and plasma norepinephrine response to exercise in the patients with graves' disease


, : Assessment of cardiac reserve and plasma norepinephrine response to exercise in the patients with graves' disease. Journal of Tokyo Medical College 49(6): 853-864

Exercise tests were conducted and cardiac reserve as well as exercise-induced changes in plasma norepinephrine (PNE), serum triiodothyronine (T3), and total serum thyroxine (T4) levels during exercise were measured in 53 cases of untreated Graves' disease (group G) and 23 normal individuals (group C). The relations between cardiac reserve and PNE in these groups were also investigated. Cardiac reserve was estimated by echocardiography and mechanocardiography. These tests and measurements were also repeated in 12 cases (group E) from the group G after a period of 5.1.+-.3.8 months following restoration of a euthryoid state. Heart rate, systolic blood pressure, mVcf and cardiac index at rest were highest in the group G, and not significantly different in the group E as compared with the group C, while no significant difference among three groups was found with respect to the values of these parameters after exercise. Resting values of left ventricular ejection fraction were not significantly different among three groups, but after exercise this parameter was significantly lower in the group G as compared with the group C. The group E displayed no significant difference from the group C in this respect. The exercise time impairment was highest in the group G, and was also significantly higher in the group E as compared with the group C. At rest, PNE levels were not significantly different among three groups. After exercise, PNE was significantly elevated in all three groups, but was significantly lower in both in the groups G and E as compared with the group C. There were no significant difference between the groups G and E with respect to the post-exercise values of PNE. The relative increment in plasma PNE after exercise (deltaPNE/PNE) was calculated, and the ratios of the relative increments of heart rate, mVcf, and CI (i. e., delteHR/HR, deltam Vcf/mVcf, and deltaCI/CI, respectively) to the former quantity (i. e., deltaHR/HR/deltaPNE/PNE, deltamV cf/mVcf/deltaPNE/PNE, and deltaCI/CIdeltaPNE/PNE, respectively) were considered. In the group G, cases displaying nearly the same values of these ratios as those observed in the group C (79%, 65%, and 62%, respectively) as well as cases displaying higher values as compared with the group C (21%, 33%, and 33%, respectively) were noted. The same was true with respect to the group E, but this group included no case displaying such values conspicuously elevated as those found in the group G. Serum levels of T3 and T4 were significantly elevated after exercise in the groups C and E, whereas exercise induced no significant change in these parameters in the group G. These findings indicate that cardiac reserve is depressed in Graves' disease, but recovers after restoration of a euthyoid state as determined by biochemical tests, and that chronotropic and inotropic responses to sympathetic activity appear to be markedly enhanced in Graves' disease although the release of PNE was reduced. The results also indicate that exercise in Graves' disease does not affect T3 and T4 secretion.

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