Muscle pump-dependent self-perfusion mechanism in legs in normal subjects and patients with heart failure.
Leg venous pressure markedly falls during upright exercise via a muscle pump effect, creating de novo perfusion pressure. We examined physiological roles of this mechanism in increasing femoral artery blood flow (FABF) and its alterations in chronic heart failure (CHF). In 10 normal subjects and 10 patients with CHF, standard hemodynamic variables, mean ankle vein pressure (MAVP), and FABF with Doppler techniques were obtained during graded upright bicycle exercise. To evaluate a nonspecific blood flow response, normal subjects also performed supine exercise. In normal subjects, MAVP rapidly declined by 45 mmHg and FABF correspondingly increased 5.3-fold without a systemic pressor response during 10 s of light upright exercise at 5 W. Approximately 67% of the blood flow response was attributed to the venous pressure drop-dependent mechanism. In CHF patients, MAVP declined by only 36 mmHg and FABF increased only 1.7-fold during the same upright exercise. The muscle venous pump has an ability to increase FABF at least threefold via the venous pressure drop-dependent mechanism. This mechanism is impaired in CHF patients.
Shiotani
Issei
I
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
Sato
Hideyuki
H
Sato
Hiroshi
H
Yokoyama
Hiroshi
H
Ohnishi
Yozo
Y
Hishida
Eiji
E
Kinjo
Kunihiro
K
Nakatani
Daisaku
D
Kuzuya
Tsunehiko
T
Hori
Masatsugu
M
D000368:Aged; D000842:Ankle / Q000098:blood supply / Q000502:physiology; D005263:Femoral Artery / Q000502:physiology; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000502:physiology*; D010101:Oxygen Consumption / Q000502:physiology; D005082:Physical Exertion / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D014680:Veins / Q000502:physiology