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. 1995 Feb;73(2):145–150. doi: 10.1136/hrt.73.2.145

Ergometric exercise testing and sensitivity of cyclic guanosine 3',5'-monophosphate (cGMP) in diagnosing asymptomatic left ventricular dysfunction.

G Jakob 1, J Mair 1, M Pichler 1, B Puschendorf 1
PMCID: PMC483781  PMID: 7696024

Abstract

OBJECTIVE--Increased plasma concentrations of cyclic guanosine monophosphate (cGMP) have been reported in patients with manifest heart failure. At rest, however, cGMP concentrations in patients with asymptomatic left ventricular dysfunction or heart failure in New York Heart Association (NYHA) functional class I do not differ significantly from those of healthy subjects. The purpose of this study was to investigate whether graded exercise on an ergometer improves the sensitivity of cGMP in diagnosing asymptomatic left ventricular dysfunction. PATIENTS--Plasma cGMP concentrations were compared in 17 healthy controls and 98 patients with asymptomatic left ventricular dysfunction or congestive heart failure of different stages (asymptomatic left ventricular dysfunction or NYHA functional class I, 56 patients; NYHA class II, 31 patients; NYHA class III, 11 patients). RESULTS--Before exercise plasma cGMP concentrations in patients with clinical heart failure (NYHA functional classes II and III) were significantly higher than those in healthy controls. In patients with asymptomatic left ventricular dysfunction or heart failure of functional class I plasma cGMP concentrations were not significantly different from those in healthy subjects. Thirty minutes after exercise, however, cGMP concentrations in patients with asymptomatic left ventricular dysfunction or class I heart failure were significantly higher than those in healthy controls. CONCLUSION--Measurement of plasma cGMP concentrations 30 minutes after ergometric exercise testing allows better discrimination between healthy subjects and patients with symptomless left ventricular dysfunction or mild heart failure (NYHA class I) than measurement of such concentrations before exercise.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altenkirch H. U., Gerzer R., Kirsch K. A., Weil J., Heyduck B., Schultes I., Röcker L. Effect of prolonged physical exercise on fluid regulating hormones. Eur J Appl Physiol Occup Physiol. 1990;61(3-4):209–213. doi: 10.1007/BF00357601. [DOI] [PubMed] [Google Scholar]
  2. Barnett D. B. Diagnosis of symptomless left ventricular dysfunction. Lancet. 1993 May 1;341(8853):1124–1125. doi: 10.1016/0140-6736(93)93132-k. [DOI] [PubMed] [Google Scholar]
  3. Donckier J. E., De Coster P. M., Buysschaert M., Levecque P., Cauwe F. M., Brichant C. M., Berbinschi A. C., Ketelslegers J. M. Effect of exercise on plasma atrial natriuretic factor and cardiac function in men and women. Eur J Clin Invest. 1988 Aug;18(4):415–419. doi: 10.1111/j.1365-2362.1988.tb01033.x. [DOI] [PubMed] [Google Scholar]
  4. Gerzer R., Weil J., Strom T., Müller T. Mechanisms of action of atrial natriuretic factor: clinical consequences. Klin Wochenschr. 1986;64 (Suppl 6):21–26. [PubMed] [Google Scholar]
  5. Gerzer R., Witzgall H., Tremblay J., Gutkowska J., Hamet P. Rapid increase in plasma and urinary cyclic GMP after bolus injection of atrial natriuretic factor in man. J Clin Endocrinol Metab. 1985 Dec;61(6):1217–1219. doi: 10.1210/jcem-61-6-1217. [DOI] [PubMed] [Google Scholar]
  6. Haug C., Metzele A., Kochs M., Hombach V., Grünert A. Plasma brain natriuretic peptide and atrial natriuretic peptide concentrations correlate with left ventricular end-diastolic pressure. Clin Cardiol. 1993 Jul;16(7):553–557. doi: 10.1002/clc.4960160708. [DOI] [PubMed] [Google Scholar]
  7. Hirata Y., Ishii M., Matsuoka H., Sugimoto T., Iizuka M., Uchida Y., Serizawa T., Sato H., Kohmoto O., Mochizuki T. Plasma concentrations of alpha-human atrial natriuretic polypeptide and cyclic GMP in patients with heart disease. Am Heart J. 1987 Jun;113(6):1463–1469. doi: 10.1016/0002-8703(87)90663-6. [DOI] [PubMed] [Google Scholar]
  8. Hirata Y., Tomita M., Takada S., Yoshimi H. Vascular receptor binding activities and cyclic GMP responses by synthetic human and rat atrial natriuretic peptides (ANP) and receptor down-regulation by ANP. Biochem Biophys Res Commun. 1985 Apr 30;128(2):538–546. doi: 10.1016/0006-291x(85)90080-4. [DOI] [PubMed] [Google Scholar]
  9. Jakob G., Mair J., Puschendorf B. Direct determination of cyclic guanosine monophosphate in plasma. Clin Chem. 1993 Dec;39(12):2530–2531. [PubMed] [Google Scholar]
  10. Jakob G., Mair J., Puschendorf B. On the relation of atrial natriuretic peptide and cyclic guanosine 3',5'-monophosphate plasma concentrations during ergometric exercise in healthy individuals. Horm Metab Res. 1994 Feb;26(2):121–122. doi: 10.1055/s-2007-1000788. [DOI] [PubMed] [Google Scholar]
  11. Kuzmits R., Schernthaner G. Influence of metabolic control of insulin-dependent diabetes on plasma nucleotide levels (cAMP, cGMP) during bicycle exercise. Diabet Med. 1986 Sep-Oct;3(5):441–444. doi: 10.1111/j.1464-5491.1986.tb00787.x. [DOI] [PubMed] [Google Scholar]
  12. Leinonen H., Näveri H., Tikkanen I., Sovijärvi A., Fyhrquist F. Basal and exercise plasma levels of atrial natriuretic factor in congestive heart failure. Am Heart J. 1988 Jul;116(1 Pt 1):209–211. doi: 10.1016/0002-8703(88)90277-3. [DOI] [PubMed] [Google Scholar]
  13. Lerman A., Gibbons R. J., Rodeheffer R. J., Bailey K. R., McKinley L. J., Heublein D. M., Burnett J. C., Jr Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction. Lancet. 1993 May 1;341(8853):1105–1109. doi: 10.1016/0140-6736(93)93125-k. [DOI] [PubMed] [Google Scholar]
  14. Maddahi J., Berman D. S., Matsuoka D. T., Waxman A. D., Stankus K. E., Forrester J. S., Swan H. J. A new technique for assessing right ventricular ejection fraction using rapid multiple-gated equilibrium cardiac blood pool scintigraphy. Description, validation and findings in chronic coronary artery disease. Circulation. 1979 Sep;60(3):581–589. doi: 10.1161/01.cir.60.3.581. [DOI] [PubMed] [Google Scholar]
  15. Nelesen R. A., Dimsdale J. E., Ziegler M. G. Plasma atrial natriuretic peptide is unstable under most storage conditions. Circulation. 1992 Aug;86(2):463–466. doi: 10.1161/01.cir.86.2.463. [DOI] [PubMed] [Google Scholar]
  16. Nishikimi T., Kohno M., Matsuura T., Akioka K., Teragaki M., Yasuda M., Oku H., Takeuchi K., Takeda T. Effect of exercise on circulating atrial natriuretic polypeptide in valvular heart disease. Am J Cardiol. 1986 Nov 15;58(11):1119–1120. doi: 10.1016/0002-9149(86)90131-1. [DOI] [PubMed] [Google Scholar]
  17. Okada F., Honma M., Ui M. Changes in plasma cyclic nucleotides levels during various acute physical stresses. Horm Metab Res. 1980 Feb;12(2):80–83. doi: 10.1055/s-2007-996206. [DOI] [PubMed] [Google Scholar]
  18. Packer M. Neurohormonal interactions and adaptations in congestive heart failure. Circulation. 1988 Apr;77(4):721–730. doi: 10.1161/01.cir.77.4.721. [DOI] [PubMed] [Google Scholar]
  19. Packer M. The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol. 1992 Jul;20(1):248–254. doi: 10.1016/0735-1097(92)90167-l. [DOI] [PubMed] [Google Scholar]
  20. Pichler M., Mostbeck G., Fridrich L., Eghbalian F., Gassner A. Scintigraphic left ventricular function during exercise in elderly patients with coronary artery disease. Eur Heart J. 1984 Nov;5 (Suppl E):55–57. doi: 10.1093/eurheartj/5.suppl_e.55. [DOI] [PubMed] [Google Scholar]
  21. Saito Y., Nakao K., Sugawara A., Nishimura K., Sakamoto M., Morii N., Yamada T., Itoh H., Shiono S., Kuriyama T. Atrial natriuretic polypeptide during exercise in healthy man. Acta Endocrinol (Copenh) 1987 Sep;116(1):59–65. doi: 10.1530/acta.0.1160059. [DOI] [PubMed] [Google Scholar]
  22. Struthers A. D. Plasma concentrations of brain natriuretic peptide: will this new test reduce the need for cardiac investigations? Br Heart J. 1993 Nov;70(5):397–398. doi: 10.1136/hrt.70.5.397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tanaka H., Shindo M., Gutkowska J., Kinoshita A., Urata H., Ikeda M., Arakawa K. Effect of acute exercise on plasma immunoreactive-atrial natriuretic factor. Life Sci. 1986 Nov 3;39(18):1685–1693. doi: 10.1016/0024-3205(86)90166-9. [DOI] [PubMed] [Google Scholar]
  24. Tsutamoto T., Kanamori T., Morigami N., Sugimoto Y., Yamaoka O., Kinoshita M. Possibility of downregulation of atrial natriuretic peptide receptor coupled to guanylate cyclase in peripheral vascular beds of patients with chronic severe heart failure. Circulation. 1993 Jan;87(1):70–75. doi: 10.1161/01.cir.87.1.70. [DOI] [PubMed] [Google Scholar]
  25. Tsutamoto T., Kanamori T., Wada A., Kinoshita M. Uncoupling of atrial natriuretic peptide extraction and cyclic guanosine monophosphate production in the pulmonary circulation in patients with severe heart failure. J Am Coll Cardiol. 1992 Sep;20(3):541–546. doi: 10.1016/0735-1097(92)90005-8. [DOI] [PubMed] [Google Scholar]
  26. Vorderwinkler K. P., Artner-Dworzak E., Jakob G., Mair J., Diensti F., Pichler M., Puschendorf B. Release of cyclic guanosine monophosphate evaluated as a diagnostic tool in cardiac diseases. Clin Chem. 1991 Feb;37(2):186–190. [PubMed] [Google Scholar]
  27. Wencker M., Hauptlorenz S., Moll W., Puschendorf B. Influence of blood pressure, heart rate, age, and sex on concentrations of atrial natriuretic factor and cyclic GMP in 124 volunteers. Clin Chem. 1989 Jul;35(7):1519–1523. [PubMed] [Google Scholar]

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