title: Acetylcholinesterase inhibition with pyridostigmine improves heart rate recovery after maximal exercise in patients with chronic heart failure.
abstract: OBJECTIVE
  To characterise the effects of acetylcholinesterase inhibition with pyridostigmine on parasympathetic tone in patients with chronic heart failure (CHF).
  
  
  METHODS
  Prospective randomised, double blind crossover trial.
  
  
  METHODS
  University hospital outpatient heart failure clinic.
  
  
  METHODS
  20 ambulatory subjects with stable CHF (mean age 55 years, mean ejection fraction 24%).
  
  
  METHODS
  Oral administration of a single dose of pyridostigmine 30 mg and matching placebo on separate days.
  
  
  METHODS
  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.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Androne
authors.forename: K
authors.initials: K
authors.lastname: Hryniewicz
authors.forename: R
authors.initials: R
authors.lastname: Goldsmith
authors.forename: A
authors.initials: A
authors.lastname: Arwady
authors.forename: S D
authors.initials: SD
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000503:physiopathology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011729:Pyridostigmine Bromide / Q000627:therapeutic use*
chemical_list: D002800:Cholinesterase Inhibitors; D011729:Pyridostigmine Bromide