Journal article
Evidence of impaired functional sympatholysis in patients with heart failure with preserved ejection fraction
American journal of physiology. Heart and circulatory physiology, Vol.325(4), pp.H806-H813
10/01/2023
DOI: 10.1152/ajpheart.00450.2023
PMCID: PMC10659321
PMID: 37566111
Abstract
Exercising muscle blood flow is reduced in patients with heart failure with a preserved ejection fraction (HFpEF), which may be related to disease-related changes in the ability to overcome sympathetic nervous system (SNS)-mediated vasoconstriction during exercise, (i.e., "functional sympatholysis"). Thus, in 12 patients with HFpEF (69 ± 7 yr) and 11 healthy controls (Con, 69 ± 4 yr), we examined forearm blood flow (FBF), mean arterial pressure (MAP), and forearm vascular conductance (FVC) during rhythmic handgrip exercise (HG) at 30% of maximum voluntary contraction with or without lower-body negative pressure (LBNP, -20 mmHg) to increase SNS activity and elicit peripheral vasoconstriction. SNS-mediated vasoconstrictor responses were determined as LBNP-induced changes (%Δ) in FVC, and the "magnitude of sympatholysis" was calculated as the difference between responses at rest and during exercise. At rest, the LBNP-induced change in FVC was significantly lesser in HFpEF compared with Con (HFpEF: -9.5 ± 5.5 vs. Con: -21.0 ± 8.0%;
< 0.01). During exercise, LBNP-induced %ΔFVC was significantly attenuated in Con compared with rest (HG: -5.8 ± 6.0%;
< 0.05) but not in HFpEF (HG: -9.9 ± 2.5%;
= 0.88). Thus, the magnitude of sympatholysis was lesser in HFpEF compared with Con (HFpEF: 0.4 ± 4.7 vs. Con: -15.2 ± 11.8%;
< 0.01). These data demonstrate a diminished ability to attenuate SNS-mediated vasoconstriction in HFpEF and provide new evidence suggesting impaired functional sympatholysis in this patient group.
Data from the current study suggest that functional sympatholysis, or the ability to adequately attenuate sympathetic nervous system (SNS)-mediated vasoconstriction during exercise, is impaired in patients with heart failure with preserved ejection fraction (HFpEF). These observations extend the current understanding of HFpEF pathophysiology by implicating inadequate functional sympatholysis as an important contributor to reduced exercising muscle blood flow in this patient group.
Details
- Title: Subtitle
- Evidence of impaired functional sympatholysis in patients with heart failure with preserved ejection fraction
- Creators
- Jeremy K Alpenglow - University of UtahKanokwan Bunsawat - University of UtahMichael A Francisco - University of UtahJesse C Craig - Geriatric Research Education and Clinical CenterJarred J Iacovelli - University of UtahJohn J Ryan - University of UtahD Walter Wray - University of Utah
- Resource Type
- Journal article
- Publication Details
- American journal of physiology. Heart and circulatory physiology, Vol.325(4), pp.H806-H813
- DOI
- 10.1152/ajpheart.00450.2023
- PMID
- 37566111
- PMCID
- PMC10659321
- NLM abbreviation
- Am J Physiol Heart Circ Physiol
- ISSN
- 0363-6135
- eISSN
- 1522-1539
- Grant note
- R01 HL162856 / NHLBI NIH HHS I01 CX002152 / CSRD VA I01 RX003343 / RRD VA IK2 RX003670 / RRD VA T32 HL139451 / NHLBI NIH HHS
- Language
- English
- Date published
- 10/01/2023
- Academic Unit
- Health, Sport, and Human Physiology
- Record Identifier
- 9984948145002771
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