title: Hemodynamic response to muscle reflex is abnormal in patients with heart failure with preserved ejection fraction.
abstract: The aim of the present investigation was to assess the role of cardiac diastole on the hemodynamic response to metaboreflex activation. We wanted to determine whether patients with diastolic function impairment showed a different hemodynamic response compared with normal subjects during this reflex. Hemodynamics during activation of the metaboreflex obtained by postexercise muscle ischemia (PEMI) was assessed in 10 patients with diagnosed heart failure with preserved ejection fraction (HFpEF) and in 12 age-matched healthy controls (CTL). Subjects also performed a control exercise-recovery test to compare data from the PEMI test. The main results were that patients with HFpEF achieved a similar mean arterial blood pressure (MAP) response as the CTL group during the PEMI test. However, the mechanism by which this response was achieved was markedly different between the two groups. Patients with HFpEF achieved the target MAP via an increase in systemic vascular resistance (+389.5 ± 402.9 vs. +80 ± 201.9 dynes·s-1·cm-5for HFpEF and CTL groups respectively), whereas MAP response in the CTL group was the result of an increase in cardiac preload (-1.3 ± 5.2 vs. 6.1 ± 10 ml in end-diastolic volume for HFpEF and CTL groups, respectively), which led to a rise in stroke volume and cardiac output. Moreover, early filling peak velocities showed a higher response in the CTL group than in the HFpEF group. This study demonstrates that diastolic function is important for normal hemodynamic adjustment to the metaboreflex. Moreover, it provides evidence that HFpEF causes hemodynamic impairment similar to that observed in systolic heart failure.NEW & NOTEWORTHYThis study provides evidence that diastolic function is important for normal hemodynamic responses during the activation of the muscle metaboreflex in humans. Moreover, it demonstrates that diastolic impairment leads to hemodynamic consequences similar to those provoked by systolic heart failure. In both cases the target blood pressure is obtained mainly by means of exaggerated vasoconstriction than by a flow-mediated mechanism.
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and.
authors.forename: Silvana
authors.initials: S
authors.lastname: Roberto
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Mulliri
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Milia
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and.
authors.forename: Roberto
authors.initials: R
authors.lastname: Solinas
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and.
authors.forename: Virginia
authors.initials: V
authors.lastname: Pinna
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and.
authors.forename: Gianmarco
authors.initials: G
authors.lastname: Sainas
authors.affiliation: Royal Brompton Hospital, Imperial College, London, United Kingdom.
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.affiliation: Department of Medical Sciences, Sports Physiology Lab., University of Cagliari, Cagliari, Italy; and crisafulli@tiscali.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Crisafulli
mesh_terms: D062186:Arterial Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D003971:Diastole / Q000502:physiology; D015444:Exercise / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D012026:Reflex, Stretch / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology
keywords: blood pressure; cardiac preload; myocardial contractility; stroke volume