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Cardiovascular responses to static handgrip exercise and postexercise ischemia in heart failure with preserved ejection fraction
Journal article   Peer reviewed

Cardiovascular responses to static handgrip exercise and postexercise ischemia in heart failure with preserved ejection fraction

Kanokwan Bunsawat, Heather L Clifton, Stephen M Ratchford, Jennifer R Vranish, Jeremy K Alpenglow, Mark J Haykowsky, Joel D Trinity, John J Ryan, Paul J Fadel and D Walter Wray
Journal of applied physiology (1985), Vol.134(6), pp.1508-1519
06/01/2023
DOI: 10.1152/japplphysiol.00045.2023
PMCID: PMC10259865
PMID: 37167264
url
https://www.ncbi.nlm.nih.gov/pmc/articles/10259865View
Open Access

Abstract

Heart failure with preserved ejection fraction (HFpEF) is characterized by reduced ability to sustain physical activity that may be due partly to disease-related changes in autonomic function that contribute to dysregulated cardiovascular control during muscular contraction. Thus, we used a combination of static handgrip exercise (HG) and postexercise ischemia (PEI) to examine the pressor response to exercise and isolate the skeletal muscle metaboreflex, respectively. Mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) were assessed during 2-min of static HG at 30 and 40% of maximum voluntary contraction (MVC) and subsequent PEI in 16 patients with HFpEF and 17 healthy, similarly aged controls. Changes in MAP were lower in patients with HFpEF compared with controls during both 30%MVC (Δ11 ± 7 vs. Δ15 ± 8 mmHg) and 40%MVC (Δ19 ± 14 vs. Δ30 ± 8 mmHg), and a similar pattern of response was evident during PEI (30%MVC: Δ8 ± 5 vs. Δ12 ± 8 mmHg; 40%MVC: Δ13 ± 10 vs. Δ18 ± 9 mmHg) (group effect: = 0.078 and = 0.017 at 30% and 40% MVC, respectively). Changes in HR, CO, and TPR did not differ between groups during HG or PEI ( > 0.05). Taken together, these data suggest a reduced pressor response to static muscle contractions in patients with HFpEF compared with similarly aged controls that may be mediated partly by a blunted muscle metaboreflex. These findings support a disease-related dysregulation in neural cardiovascular control that may reduce an ability to sustain physical activity in HFpEF. The current investigation has identified a diminution in the exercise-induced rise in arterial blood pressure (BP) that persisted during postexercise ischemia (PEI) in an intensity-dependent manner in patients with heart failure with preserved ejection fraction (HFpEF) compared with older, healthy controls. These findings suggest that the pressor response to exercise is reduced in patients with HFpEF, and this deficit may be mediated, in part, by a blunted muscle metaboreflex, highlighting the consequences of impaired neural cardiovascular control during exercise in this patient group.
 Blood Pressure - physiology Exercise - physiology Hand Strength - physiology Heart Failure Humans Ischemia Muscle, Skeletal - physiology Reflex - physiology Stroke Volume

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