Satyam Sarma1,2, Erin Howden3, Justin Lawley4, Mitchel Samels1, Benjamin D Levine1,2. 1. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (S.S., M.S., B.D.L.). 2. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (S.S., B.D.L.). 3. Baker Heart and Diabetes Institute, Melbourne, Australia (E.H.). 4. Department of Sport Science, University of Innsbruck, Austria (J.L.).
Abstract
BACKGROUND: Chronotropic incompetence is common in heart failure with preserved ejection fraction (HFpEF) and is linked to impaired aerobic capacity. Whether upstream autonomic signaling pathways responsible for raising exercise heart rate are impaired in HFpEF is unknown. We investigated the integrity of central command and muscle metaboreceptor function, 2 predominant mechanisms responsible for exertional increases in heart rate, in patients with HFpEF and senior controls. METHODS: Fourteen healthy senior controls (7 men, 7 women) and 20 carefully screened patients with HFpEF (8 men, 12 women) underwent cardiopulmonary exercise testing (peak Vo2) and static handgrip exercise at 40% of maximal voluntary contraction to fatigue with postexercise circulatory arrest for 2 minutes to assess central command and metaboreceptor function, respectively. RESULTS: Peak Vo2 (13.1±3.4 versus 22.7±4.0 mL/kg/min; P<0.001) and heart rate (122±20 versus 155±14 bpm; P<0.001) were lower in patients with HFpEF than senior controls. There were no significant differences in peak heart rate response during static handgrip between groups (patients with HFpEF versus controls: 90±13 versus 93±10 bpm; P=0.49). Metaboreceptor function, defined as mean arterial blood pressure at the end of postexercise circulatory arrest, was not significantly different between groups. CONCLUSIONS: Central command (vagally mediated) and metaboreceptor function (sympathetically mediated) in patients with HFpEF were not different from those in healthy senior controls despite significantly lower peak whole-body exercise heart rates. These results demonstrate key reflex autonomic pathways regulating exercise heart rate responsiveness are intact in HFpEF.
BACKGROUND: Chronotropic incompetence is common in heart failure with preserved ejection fraction (HFpEF) and is linked to impaired aerobic capacity. Whether upstream autonomic signaling pathways responsible for raising exercise heart rate are impaired in HFpEF is unknown. We investigated the integrity of central command and muscle metaboreceptor function, 2 predominant mechanisms responsible for exertional increases in heart rate, in patients with HFpEF and senior controls. METHODS: Fourteen healthy senior controls (7 men, 7 women) and 20 carefully screened patients with HFpEF (8 men, 12 women) underwent cardiopulmonary exercise testing (peak Vo2) and static handgrip exercise at 40% of maximal voluntary contraction to fatigue with postexercise circulatory arrest for 2 minutes to assess central command and metaboreceptor function, respectively. RESULTS: Peak Vo2 (13.1±3.4 versus 22.7±4.0 mL/kg/min; P<0.001) and heart rate (122±20 versus 155±14 bpm; P<0.001) were lower in patients with HFpEF than senior controls. There were no significant differences in peak heart rate response during static handgrip between groups (patients with HFpEF versus controls: 90±13 versus 93±10 bpm; P=0.49). Metaboreceptor function, defined as mean arterial blood pressure at the end of postexercise circulatory arrest, was not significantly different between groups. CONCLUSIONS: Central command (vagally mediated) and metaboreceptor function (sympathetically mediated) in patients with HFpEF were not different from those in healthy senior controls despite significantly lower peak whole-body exercise heart rates. These results demonstrate key reflex autonomic pathways regulating exercise heart rate responsiveness are intact in HFpEF.
Authors: C E Negrão; M U Rondon; T Tinucci; M J Alves; F Roveda; A M Braga; S F Reis; L Nastari; A C Barretto; E M Krieger; H R Middlekauff Journal: Am J Physiol Heart Circ Physiol Date: 2001-03 Impact factor: 4.733
Authors: Antonio Crisafulli; Adam C Scott; Roland Wensel; Costantinos H Davos; Darrel P Francis; Pasquale Pagliaro; Andrew J S Coats; Alberto Concu; Massimo F Piepoli Journal: Med Sci Sports Exerc Date: 2003-02 Impact factor: 5.411
Authors: E Ashley Hardin; Douglas Stoller; Justin Lawley; Erin J Howden; Michinari Hieda; James Pawelczyk; Sara Jarvis; Kim Prisk; Satyam Sarma; Benjamin D Levine Journal: J Am Heart Assoc Date: 2020-08-27 Impact factor: 5.501
Authors: Marco Guazzi; Matthias Wilhelm; Martin Halle; Emeline Van Craenenbroeck; Hareld Kemps; Rudolph A de Boer; Andrew J S Coats; Lars Lund; Donna Mancini; Barry Borlaug; Gerasimos Filippatos; Burkert Pieske Journal: Eur J Heart Fail Date: 2022-07-31 Impact factor: 17.349