Exercise Blood Pressure in Heart Failure With Preserved and Reduced Ejection Fraction

Namasivayam, Mayooran; Lau, Elizabeth T.; Zern, Emily K.; Schoenike, Mark; Hardin, Kathryn M.; Sbarbaro, John A.; Cunningham, Thomas F.; Farrell, Robyn; Rouvina, Jennifer; Kowal, Alyssa; Bhat, Rohan R.; Brooks, Liana; Nayor, Matthew; Shah, Ravi; Ho, Jennifer E.; Malhotra, Rajeev; Lewis, Gregory D.

doi:10.1016/j.jchf.2022.01.012

Cited by 6 publications

(8 citation statements)

References 31 publications

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“…During dynamic exercise, where sympathetic neural responses are likely heightened, patients with HFpEF exhibit excessive pressor responses compared to non-HF controls and patients with HFrEF ( 8 , 25 ). Kato et al ( 8 ) found that the ΔBP during maximal treadmill exercise was greater in patients with HFpEF compared to individuals with hypertension, despite similar resting BP between groups and a shorter exercise duration in patients with HFpEF.…”

Section: Hemodynamicsmentioning

confidence: 99%

“…Kato et al ( 8 ) found that the ΔBP during maximal treadmill exercise was greater in patients with HFpEF compared to individuals with hypertension, despite similar resting BP between groups and a shorter exercise duration in patients with HFpEF. Moreover, Namasivayam et al ( 25 ) directly compared BP at peak exercise workload (upright cycle ergometer) between patients with HFrEF and HFpEF, finding that greater increases in systolic and diastolic BP in individuals with HFpEF. Furthermore, they found that pulsatile BP [the ratio of pulse pressure to systolic BP which indicates the power required to deliver blood to target organs ( 51 )] was positively correlated with both arterial stiffness and SV in patients with HFpEF, but only SV in those with HFrEF.…”

Section: Hemodynamicsmentioning

confidence: 99%

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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%

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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“…Patients with HFpEF have marked arterial stiffening beyond that observed with ageing (Hundley et al, 2001) and hypertension (Desai et al, 2009), or heart failure with a reduced ejection fraction (HFrEF) (Balmain et al, 2007). In patients with HFpEF, elevations in markers of arterial stiffness and associated wave reflections are associated with impaired systolic and diastolic function at rest and adverse cardiovascular outcomes (Namasivayam et al, 2022).…”

Section: Arterial Stiffness and Aortic Haemodynamics In Hfpefmentioning

confidence: 99%

Exercise intolerance in heart failure with preserved ejection fraction: Causes, consequences and the journey towards a cure

Bunsawat,

Nelson,

Hearon

et al. 2023

Experimental Physiology

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Heart failure with preserved ejection fraction (HFpEF) accounts for over 50% of all heart failure cases nationwide and continues to rise in its prevalence. The complex, multi‐organ involvement of the HFpEF clinical syndrome requires clinicians and investigators to adopt an integrative approach that considers the contribution of both cardiac and non‐cardiac function to HFpEF pathophysiology. Thus, this symposium review outlines the key points from presentations covering the contributions of disease‐related changes in cardiac function, arterial stiffness, peripheral vascular function, and oxygen delivery and utilization to exercise tolerance in patients with HFpEF. While many aspects of HFpEF pathophysiology remain poorly understood, there is accumulating evidence for a decline in vascular health in this patient group that may be remediable through pharmacological and lifestyle interventions and could improve outcomes and clinical status in this ever‐growing patient population.

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“…25 Also non-invasive assessment of exercise blood pressure pulsatility by proportionate pulse pressure (pulse pressure/systolic blood pressure) has shown a high ratio as typical of hypertensive and obese HFpEF phenotype, correlating with peak VO 2 . 49 The microvascular peripheral circulation has an important role in O 2 delivery and utilization. Its dilator reserve is abnormal in HFpEF, due to vessel rarefaction, endothelial dysfunction and blunted response to muscle tissue hypoxic vasodilatation, all contributing to exercise limitation.…”

Section: Systemic Arterial and Venous System Abnormalitiesmentioning

confidence: 99%

“…Exercise central aortic stiffness, assessed by converting radial artery pressure waveforms to central ones, tightly correlates with peak VO 2 25 . Also non‐invasive assessment of exercise blood pressure pulsatility by proportionate pulse pressure (pulse pressure/systolic blood pressure) has shown a high ratio as typical of hypertensive and obese HFpEF phenotype, correlating with peak VO 2 49 …”

Section: Comorbidities and Extracardiac Contributors To Impaired Exer...mentioning

confidence: 99%

Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

Guazzi

Wilhelm

Halle

et al. 2022

European J of Heart Fail

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Patients with heart failure with preserved ejection fraction (HFpEF) universally complain of exercise intolerance and dyspnoea as key clinical correlates. Cardiac as well as extracardiac components play a role for the limited exercise capacity, including an impaired cardiac and peripheral vascular reserve, a limitation in mechanical ventilation and/or gas exchange with reduced pulmonary vascular reserve, skeletal muscle dysfunction and iron deficiency/anaemia. Although most of these components can be differentiated and quantified through gas exchange analysis by cardiopulmonary exercise testing (CPET), the information provided by objective measures of exercise performance has not been systematically considered in the recent algorithms/scores for HFpEF diagnosis, by neither European nor US groups. The current clinical consensus statement by the Heart Failure Association (HFA) and European Association of Preventive Cardiology (EAPC) of the European Society of Cardiology (ESC) aims at outlining the role of exercise testing and its pathophysiological, clinical and prognostic insights, addressing the implications of a thorough functional evaluation from the diagnostic algorithm to the pathophysiology and treatment perspectives of HFpEF. Along with these goals, we provide a specific analysis of the evidence that CPET is the standard for assessing, quantifying, and differentiating the origin of dyspnoea and exercise impairment and even more so when combined with echocardiography and/or invasive haemodynamic evaluation. This will lead to improved quality of diagnosis when applying the proposed scores and may also help to implement the progressive characterization of the specific HFpEF phenotypes, a critical step toward the delivery of phenotype‐specific treatments.

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Exercise Blood Pressure in Heart Failure With Preserved and Reduced Ejection Fraction

Cited by 6 publications

References 31 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

Exercise intolerance in heart failure with preserved ejection fraction: Causes, consequences and the journey towards a cure

Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy – A clinical consensus statement of the Heart Failure Association and European Association of Preventive Cardiology of the European Society of Cardiology

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