Title
Heart Failure and Movement-induced Hemodynamics: Partitioning the Impact of Central and Peripheral Dysfunction
Document Type
Article
Publication Date
2015
Embargo Period
5-17-2017
Keywords
Afferents, blood flow, exercise pressor response, mechanoreflex, passive exercise
Abstract
BACKGROUND: The complex pathophysiology of heart failure (HF) creates a challenging paradigm to differentiate the role of central and peripheral hemodynamic dysfunction during conventional exercise. Adopting a novel reductionist approach with potential clinical relevance, we studied the central and peripheral contributors to both continuous and single passive leg movement (PLM)-induced hyperemia in 14 HF patients with reduced ejection fraction (HFrEF) and 13 controls.
METHODS: Heart rate (HR), stroke volume (SV), cardiac output (CO), mean arterial pressure (MAP), and femoral artery blood flow (FBF) were recorded during PLM.
RESULTS: The FBF response (area under the curve; AUC) to 60s of continuous PLM was attenuated in the HFrEF (25±15ml AUC) compared to controls (199±34ml AUC) as were peak changes from baseline for FBF, leg vascular conductance (LVC), CO, and HR. During single PLM, increases in CO and HR were smaller and no longer different between groups, supporting the use of this modality to assess groups with disparate central hemodynamics. Interestingly, single PLM-induced hyperemia, likely predominantly driven by flow-mediated vasodilation due to minimal vessel deformation, was essentially nonexistent in the HFrEF (-9±10ml AUC) in contrast to the controls (43±25ml AUC).
CONCLUSIONS: These data fail to support a HFrEF-associated exaggeration in the mechanoreceptor driven component of the exercise pressor response. In fact, by exhibiting limited central hemodynamic responses compared to the controls, the observed attenuation in movement-induced FBF in HFrEF appears largely due to peripheral vascular dysfunction, particularly flow-mediated vasodilation.
Published In
International Journal of Cardiology
Volume
178
Pages
232-238
Recommended Citation
Witman MA, Ives SJ, Trinity JD, Groot HJ, Stehlik J, Richardson RS. Heart failure and movement-induced hemodynamics: partitioning the impact of central and peripheral dysfunction. Int J Cardiol. 2015 Jan 15;178:232-8. doi: 10.1016/j.ijcard.2014.10.044. Epub 2014 Oct 22. PubMed PMID: 25464261; PubMed Central PMCID: PMC4314508.
DOI
10.1016/j.ijcard.2014.10.044