Comparison of haemodynamic response to muscle reflex in heart failure with reduced vs. preserved ejection fraction

Moriwaki, Keishi; Fujimoto, Naoki; Omori, Taku; Miyahara, So; Kameda, Issei; Ishiyama, Masaki; Sugiura, Emiyo; Nakamori, Shiro; Dohi, Kaoru

doi:10.1002/ehf2.13682

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Conversely, in patients with HFrEF, Notarius et al ( 37 ) reported significantly higher ΔBP than non-HF controls in a 2-min bout of 30% MVC static handgrip exercise, despite similar resting BP between groups. Further, Moriwaki et al ( 27 ) compared patients with HFpEF and HFrEF during 30% MVC static handgrip, finding that mean BP during exercise had no significant difference between groups despite patients with HFpEF exhibiting higher mean BP at rest, suggesting that the pressor responses to static exercise are smaller in patients with HFpEF than HFrEF. Together, unlike patients with HFrEF, individuals with HFpEF exhibit smaller BP responses during small muscle mass, static exercise compared to non-HF controls.…”

Section: Hemodynamicsmentioning

confidence: 99%

Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction

Manabe

D’Souza

Washio

et al. 2023

Front. Cardiovasc. Med.

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Excessive sympathetic activity during exercise causes heightened peripheral vasoconstriction, which can reduce oxygen delivery to active muscles, resulting in exercise intolerance. Although both patients suffering from heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) exhibit reduced exercise capacity, accumulating evidence suggests that the underlying pathophysiology may be different between these two conditions. Unlike HFrEF, which is characterized by cardiac dysfunction with lower peak oxygen uptake, exercise intolerance in HFpEF appears to be predominantly attributed to peripheral limitations involving inadequate vasoconstriction rather than cardiac limitations. However, the relationship between systemic hemodynamics and the sympathetic neural response during exercise in HFpEF is less clear. This mini review summarizes the current knowledge on the sympathetic (i.e., muscle sympathetic nerve activity, plasma norepinephrine concentration) and hemodynamic (i.e., blood pressure, limb blood flow) responses to dynamic and static exercise in HFpEF compared to HFrEF, as well as non-HF controls. We also discuss the potential of a relationship between sympathetic over-activation and vasoconstriction leading to exercise intolerance in HFpEF. The limited body of literature indicates that higher peripheral vascular resistance, perhaps secondary to excessive sympathetically mediated vasoconstrictor discharge compared to non-HF and HFrEF, drives exercise in HFpEF. Excessive vasoconstriction also may primarily account for over elevations in blood pressure and concomitant limitations in skeletal muscle blood flow during dynamic exercise, resulting in exercise intolerance. Conversely, during static exercise, HFpEF exhibit relatively normal sympathetic neural reactivity compared to non-HF, suggesting that other mechanisms beyond sympathetic vasoconstriction dictate exercise intolerance in HFpEF.

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Section: Hemodynamicsmentioning

confidence: 99%

Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction

Manabe

D’Souza

Washio

et al. 2023

Front. Cardiovasc. Med.

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Comparison of haemodynamic response to muscle reflex in heart failure with reduced vs. preserved ejection fraction

et al. 2021

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Aims Isometric handgrip (IHG) training reduces the blood pressure in patients with hypertension. It is unclear how IHG exercise affects the haemodynamics and cardiovascular function through the muscle reflex in patients with heart failure (HF) with reduced (HFrEF) and preserved ejection fraction (HFpEF). Methods and results Twenty patients (HFrEF: n = 10, HFpEF: n = 10) underwent left ventricular (LV) pressure-volume assessments using a conductance catheter and microtip manometer to evaluate haemodynamics, LV and arterial function, and LV-arterial coupling during 3 min of IHG at 30% of maximal voluntary contraction (MVC), followed by 3 min of post-exercise circulatory arrest (PECA). Three minutes of IHG exercise produced significant and modest increases in the heart rate (HR) and LV end-systolic pressure (LVESP), respectively, in both HFpEF and HFrEF groups. In HFrEF, the increase in LVESP was caused by the variable increase in effective arterial elastance (Ea), which was counterbalanced by the increase in LV end-systolic elastance (Ees), resulting in a maintained Ees/Ea. In HFpEF, the increase in LVESP was not accompanied by changes in Ea, Ees, Ees/Ea, or LV end-diastolic pressure. LVESP during PECA was not maintained in HFpEF, suggesting smaller metabo-reflex activity in HFpEF. Conclusions The IHG exercise used in this study may increase the LVESP and LVEDP without detrimental effects on cardiac function or ventricular-arterial coupling, especially in HFpEF patients. The effects of IHG exercise on haemodynamics and ventricular-arterial coupling may be affected by the patient background and the type and intensity of the exercise.

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Cardiovascular responses to static handgrip exercise and postexercise ischemia in heart failure with preserved ejection fraction

Bunsawat

Clifton

Ratchford

et al. 2023

Journal of Applied Physiology

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Exercise intolerance is a well-described characteristic of heart failure with preserved ejection fraction (HFpEF), but whether disease-related changes in autonomic function contribute to impaired cardiovascular control during exercise is not well understood. Thus, we used a combination of static handgrip exercise (HG) and post-exercise ischemia (PEI) to examine the pressor response to exercise and isolate the skeletal muscle metaboreflex, respectively. Mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) were assessed during 2-min of static HG at 30 and 40% of maximum voluntary contraction (MVC) and subsequent PEI in sixteen patients with HFpEF and seventeen healthy, similarly aged controls. Changes in MAP were lower in patients with HFpEF compared to controls during both 30%MVC (Δ11 ± 7 vs. Δ15 ± 8 mmHg) and 40%MVC (Δ19 ± 14 vs. Δ30 ± 8 mmHg), and a similar pattern of response was evident during PEI (30%MVC: Δ8 ± 5 vs. Δ12 ± 8 mmHg; 40%MVC: Δ13 ± 10 vs. Δ18 ± 9 mmHg) (group effect: p=0.048 and p=0.020 at 30% and 40% MVC, respectively). Changes in HR, CO, and TPR did not differ between groups during HG or PEI (p>0.05). Taken together, these data suggest a reduced pressor response to static muscle contractions in patients with HFpEF compared to similarly aged controls that may be mediated, in part, by a blunted muscle metaboreflex. These findings support a disease-related dysregulation in neural cardiovascular control that may contribute to the extreme exercise intolerance present in this patient group.

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Comparison of haemodynamic response to muscle reflex in heart failure with reduced vs. preserved ejection fraction

Cited by 4 publications

References 32 publications

Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction

Sympathetic and hemodynamic responses to exercise in heart failure with preserved ejection fraction

Comparison of haemodynamic response to muscle reflex in heart failure with reduced vs. preserved ejection fraction

Cardiovascular responses to static handgrip exercise and postexercise ischemia in heart failure with preserved ejection fraction

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