Neural control of the circulation during exercise in heart failure with reduced and preserved ejection fraction

Kanokwan Bunsawat; Rachel J. Skow; Jasdeep Kaur; D. Walter Wray

doi:10.1152/ajpheart.00214.2023

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$Neural control of the circulation during exercise in heart failure with reduced and preserved ejection fraction$

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Neural control of the circulation during exercise in heart failure with reduced and preserved ejection fraction

Kanokwan Bunsawat, Rachel J. Skow, Jasdeep Kaur and D. Walter Wray

American journal of physiology. Heart and circulatory physiology, Vol.325(5), pp.H998-H1011

Exercise, Physical Activity, and Cardiovascular Health

11/01/2023

DOI: 10.1152/ajpheart.00214.2023

PMCID: PMC10907034

PMID: 37682236

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https://www.ncbi.nlm.nih.gov/pmc/articles/10907034View

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Abstract

Patients with heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) exhibit severe exercise intolerance that may be due, in part, to inappropriate cardiovascular and hemodynamic adjustments to exercise. Several neural mechanisms and locally released vasoactive substances work in concert through complex interactions to ensure proper adjustments to meet the metabolic demands of the contracting skeletal muscle. Specifically, accumulating evidence suggests that disease-related alterations in neural mechanisms (e.g., central command, exercise pressor reflex, arterial baroreflex, and cardiopulmonary baroreflex) contribute to heightened sympathetic activation and impaired ability to attenuate sympathetic vasoconstrictor responsiveness that may contribute to reduced skeletal muscle blood flow and severe exercise intolerance in patients with HFrEF. In contrast, little is known regarding these important aspects of physiology in patients with HFpEF, though emerging data reveal heightened sympathetic activation and attenuated skeletal muscle blood flow during exercise in this patient population that may be attributable to dysregulated neural control of the circulation. The overall goal of this review is to provide a brief overview of the current understanding of disease-related alterations in the integrative neural cardiovascular responses to exercise in both HFrEF and HFpEF phenotypes, with a focus on sympathetic nervous system regulation during exercise.

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Title: Subtitle: Neural control of the circulation during exercise in heart failure with reduced and preserved ejection fraction
Creators: Kanokwan Bunsawat - George E. Wahlen Department of VA Medical Center
Rachel J. Skow - The University of Texas at Arlington
Jasdeep Kaur - The University of Texas at Austin
D. Walter Wray - University of Utah
Resource Type: Journal article
Publication Details: American journal of physiology. Heart and circulatory physiology, Vol.325(5), pp.H998-H1011
Series: Exercise, Physical Activity, and Cardiovascular Health
DOI: 10.1152/ajpheart.00214.2023
PMID: 37682236
PMCID: PMC10907034
NLM abbreviation: Am J Physiol Heart Circ Physiol
ISSN: 0363-6135
eISSN: 1522-1539
Publisher: American Physiological Society
Alternative title: NEUROVASCULAR DYSREGULATION IN HFrEF AND HFpEF
Language: English
Date published: 11/01/2023
Academic Unit: Health, Sport, and Human Physiology
Record Identifier: 9984948145502771

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