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Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure
  1. A S Androne1,
  2. K Hryniewicz1,
  3. R Goldsmith2,
  4. A Arwady2,
  5. S D Katz1
  1. 1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Medicine, Columbia University College of Physicians & Surgeons, New York City, New York, USA
  1. Correspondence to:
    Dr S D Katz, Yale University School of Medicine, 135 College Street, Suite 301, New Haven, CT 06510, USA;
    stuart.katz{at}yale.edu

Abstract

Objective: To characterise the effects of acetylcholinesterase inhibition with pyridostigmine on parasympathetic tone in patients with chronic heart failure (CHF).

Design: Prospective randomised, double blind crossover trial.

Setting: University hospital outpatient heart failure clinic.

Patients: 20 ambulatory subjects with stable CHF (mean age 55 years, mean ejection fraction 24%).

Interventions: Oral administration of a single dose of pyridostigmine 30 mg and matching placebo on separate days.

Main outcome measures: Heart rate recovery at one minute and three minutes after completion of maximal exercise.

Results: Heart rate recovery at one minute after exercise was significantly greater after administration of pyridostigmine than after administration of placebo (mean (SEM) 27.4 (3.2) beats/min v 22.4 (2.4) beats/min, p < 0.01). Heart rate recovery at three minutes after exercise did not differ after administration of pyridostigmine and placebo (mean (SEM) 44.4 (3.9) beats/min v 41.8 (3.6) beats/min, NS). Peak heart rate, peak oxygen uptake, peak respiratory exchange ratio, plasma noradrenaline (norepinephrine) concentrations, and plasma brain natriuretic peptide concentrations did not differ after administration of pyridostigmine and placebo.

Conclusions: Acetylcholinesterase inhibition with pyridostigmine increased heart rate recovery at one minute but not at three minutes after exercise. A specific effect of pyridostigmine on heart rate one minute after exercise suggests that pyridostigmine augments parasympathetic tone in patients with CHF.

  • autonomic nervous system
  • parasympathetic nervous system
  • autonomic agents
  • exercise physiology
  • BNP, brain natriuretic peptide
  • CHF, chronic heart failure
  • NYHA, New York Heart Association
  • co2, carbon dioxide production
  • V̇E, ventilation
  • o 2
  • oxygen uptake
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