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Int J Cardiol. 2016 May 15;211:14-21. doi: 10.1016/j.ijcard.2016.02.139. Epub 2016 Mar 2.

Impaired skeletal muscle vasodilation during exercise in heart failure with preserved ejection fraction.

Author information

1
Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States; Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, UT, United States.
2
Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, UT, United States; Department of Exercise & Sport Science, University of Utah, Salt Lake City, UT, United States.
3
Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States.
4
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States.
5
Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States; Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, UT, United States; Department of Exercise & Sport Science, University of Utah, Salt Lake City, UT, United States.
6
Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States; Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, UT, United States; Department of Exercise & Sport Science, University of Utah, Salt Lake City, UT, United States. Electronic address: walter.wray@hsc.utah.edu.

Abstract

BACKGROUND:

Exercise intolerance is a hallmark symptom of heart failure patients with preserved ejection fraction (HFpEF), which may be related to an impaired ability to appropriately increase blood flow to the exercising muscle.

METHODS:

We evaluated leg blood flow (LBF, ultrasound Doppler), heart rate (HR), stroke volume (SV), cardiac output (CO), and mean arterial blood pressure (MAP, photoplethysmography) during dynamic, single leg knee-extensor (KE) exercise in HFpEF patients (n=21; 68 ± 2 yrs) and healthy controls (n=20; 71 ± 2 yrs).

RESULTS:

HFpEF patients exhibited a marked attrition during KE exercise, with only 60% able to complete the exercise protocol. In participants who completed all exercise intensities (0-5-10-15 W; HFpEF, n=13; Controls, n=16), LBF was not different at 0 W and 5 W, but was 15-25% lower in HFpEF compared to controls at 10 W and 15 W (P<0.001). Likewise, leg vascular conductance (LVC), an index of vasodilation, was not different at 0 W and 5 W, but was 15-20% lower in HFpEF compared to controls at 10 W and 15 W (P<0.05). In contrast to these peripheral deficits, exercise-induced changes in central variables (HR, SV, CO), as well as MAP, were similar between groups.

CONCLUSIONS:

These data reveal a marked reduction in LBF and LVC in HFpEF patients during exercise that cannot be attributed to a disease-related alteration in central hemodynamics, suggesting that impaired vasodilation in the exercising skeletal muscle vasculature may play a key role in the exercise intolerance associated with this patient population.

KEYWORDS:

Blood flow; Exercise; HFpEF; Heart failure; Vasodilation

PMID:
26970959
PMCID:
PMC4834272
DOI:
10.1016/j.ijcard.2016.02.139
[Indexed for MEDLINE]
Free PMC Article

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