Isometric exercise in patients with chronic advanced heart failure: hemodynamic and neurohumoral evaluation.

Abstract

We evaluated the hemodynamic effects of isometric exercise in 53 patients with congestive heart failure (CHF) and compared them with those found in 10 normal subjects. In both groups, isometric exercise increased heart rate and blood pressure. Systemic resistance increased in patients with CHF (1862 + 520 vs 2126 ± 642 dyne-sec-cm-5; p < .001) but not in normal subjects (1359 + 268 vs 1380 ± 252 dyne-sec-cm-5). Cardiac index and stroke volume index increased mildly but not significantly in the normal subjects (2.8 0.5 vs 3. 1 ± 0.7 liters/min/m2 and 46 + 8 vs 47 ± 7 mI/M2) and showed a significant fall in the patients with CHF (2.1 ± 0.6 to 1.9 ± 0.6 liters/min/m2, p < .01 and 23 ± 7 vs 20 + 7 ml/m2, p < .01). Mean pulmonary arterial wedge pressure increased in patients with CHF from 26 ± 7 to 30 ± 8 mm Hg (p < .001). Although no significant change was found in mean value for stroke work index (21 ± 9 vs 20 + 9 g-m/m2), the individual changes were variable, with marked decrease (>15%) in 17 of the patients. This hemodynamic deterioration could not be predicted from resting hemodynamics, left ventricular ejection fraction, or functional classification. Isometric exercise resulted in no significant change in circulatory catecholamine levels or plasma renin concentration in our 10 normal subjects. In the patients with CHF renin (measured in 12 patients) and epinephrine (measured in 16 patients) also did not change during isometric exercise, but norepinephrine levels (measured in 16 patients) increased significantly. No correlation was found between changes in hormonal levels and any of the hemodynamic changes during static exercise. We conclude that in patients with chronic CHF, isometric exercise can lead to a significant increase in left ventricular outflow resistance and filling pressure and to a fall in cardiac performance. In the presence of CHF, this form of exercise results in a consistent elevation in norepinephrine levels, but there is no correlation between changes in its plasma level and in hemodynamic values. There is considerable individual variation in the hemodynamic response, with a significant deterioration in cardiac performance in some patients, which cannot be separated by resting hemodynamic values, left ventricular ejection fraction, or clinical status.Circulation 72, No. 5, 975-981, 1985.

Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output

“…Nishikawa et al (30) demonstrated that with exercise, left atrial reservoir function increased by 37% and left atrial conduit function decreased by 23%. Although Nishikawa et al did not measure PA pressures, others have demonstrated that substantial pulmonary hypertension can develop during exercise, especially in subjects with abnormal hearts (7,18,23,32). For example, in heart transplant recipients, Pflugfelder et al (32) noted that peak exercise produced a 90% increase in mean PA pressure with a threefold rise in RAP.…”

Team Management of Patients With Heart Failure

“…[45][46][47] To date, there are no data on the benefit or harm of a strength or resistance exercise program. Given the threat of complications related to increased myocardial oxygen demand in the face of isometric exercise, 48 patients are usually counseled to avoid lifting a significant weight (eg, Ͼ20 lb) or performing exercises that cause a patient to strain (eg, performing a Valsalva maneuver).…”

Haemodynamic Effects of Slow-Release Nifedipine in Severe Congestive Heart Failure due to Ischaemic Heart Disease

“…Haemo dynamic response to static exercise was not modified by treatment, though the beneficial effects of NIF at rest were maintained during static exercise. NIF therefore seems to bring baseline haemodynamics back to a very fa vourable level, reducing changes which oc cur in severe CHF patients after isometric exercise while the basic CHF patients re main essentially unchanged [33].…”