Impaired Chronotropic and Vasodilator Reserves Limit Exercise Capacity in Patients With Heart Failure and a Preserved Ejection Fraction

@article{Borlaug2006ImpairedCA,
  title={Impaired Chronotropic and Vasodilator Reserves Limit Exercise Capacity in Patients With Heart Failure and a Preserved Ejection Fraction},
  author={Barry A. Borlaug and Vojtěch Melenovsk{\'y} and Stuart D. Russell and Kristy Kessler and Karel Pacak and L.C. Becker and David A. Kass},
  journal={Circulation},
  year={2006},
  volume={114},
  pages={2138-2147}
}
Background— Nearly half of patients with heart failure have a preserved ejection fraction (HFpEF). Symptoms of exercise intolerance and dyspnea are most often attributed to diastolic dysfunction; however, impaired systolic and/or arterial vasodilator reserve under stress could also play an important role. Methods and Results— Patients with HFpEF (n=17) and control subjects without heart failure (n=19) generally matched for age, gender, hypertension, diabetes mellitus, obesity, and the presence… 

Figures and Tables from this paper

Resting Ventricular–Vascular Function and Exercise Capacity in Heart Failure With Preserved Ejection Fraction: A RELAX Trial Ancillary Study
TLDR
In heart failure with preserved ejection fraction, potentially modifiable factors (obesity, anemia, and chronotropic incompetence) are strongly associated with exercise capacity, whereas resting measures of ventricular and vascular structure and function are not.
Impaired Heart Rate Recovery and Chronotropic Incompetence in Patients With Heart Failure With Preserved Ejection Fraction
TLDR
Patients with heart failure with preserved left ventricular ejection fraction have impaired chronotropic incompetence during maximal exercise and abnormal HR recovery after exercise.
The Benefits of Exercise Training on Aerobic Capacity in Patients with Heart Failure and Preserved Ejection Fraction.
TLDR
The primary purpose of this chapter was to clarify the physiological mechanisms associated with reduced aerobic capacity in HFpEF patients and special focus was devoted to show how aerobic exercise training can improve aerobic capacity and quality of life in HF pEF patients.
Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: The Role of Abnormal Peripheral Oxygen Extraction
TLDR
It is found that peak C(a-v)o2 was a major determinant of exercise capacity in HFpEF, and represents a potential target for therapeutic intervention.
...
...

References

SHOWING 1-10 OF 54 REFERENCES
Exercise intolerance in patients with chronic heart failure: role of impaired nutritive flow to skeletal muscle.
TLDR
The data suggest that the reduced maximal exercise capacity of patients with chronic heart failure is primarily due to impaired nutritive flow to skeletal muscle and resultant muscular fatigue.
Combined Ventricular Systolic and Arterial Stiffening in Patients With Heart Failure and Preserved Ejection Fraction: Implications for Systolic and Diastolic Reserve Limitations
TLDR
Patients with HF-lnEF have systolic-ventricular and arterial stiffening beyond that associated with aging and/or hypertension, which may play an important pathophysiological role by exacerbating systemic load interaction with diastolic function, augmenting blood pressure lability, and elevating cardiac metabolic demand under stress.
Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics.
TLDR
SV is the major determinant of peak exercise capacity in the erect position in patients with hypertrophic cardiomyopathy, which in turn is determined by the exercise left ventricular diastolic filling characteristics.
Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure. Muscle blood flow is reduced with maintenance of arterial perfusion pressure.
TLDR
In patients with chronic heart failure compared with normal subjects, skeletal muscle perfusion is decreased at rest and during submaximal and maximal exercise, and local vascular resistance is increased, providing further evidence that reduced perfusion of skeletal muscle is important in causing early anaerobic skeletal muscle metabolism during exercise in subjects with this disorder.
Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure.
TLDR
Patients with isolated DHF have similar though not as severe pathophysiologic characteristics compared with patients with typical SHF, including severely reduced exercise capacity, neuroendocrine activation, and impaired quality of life.
Dissociation between exertional symptoms and circulatory function in patients with heart failure.
TLDR
The level of exercise intolerance perceived by patients with heart failure has little or no relation to objective measures of circulatory, ventilatory, or metabolic dysfunction during exercise.
...
...