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Locomotor muscle group III/IV afferents constrain stroke volume and contribute to exercise intolerance in human heart failure
Author(s) -
Smith Joshua R.,
Joyner Michael J.,
Curry Timothy B.,
Borlaug Barry A.,
KellerRoss Manda L.,
Van Iterson Erik H.,
Olson Thomas P.
Publication year - 2020
Publication title -
the journal of physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.802
H-Index - 240
eISSN - 1469-7793
pISSN - 0022-3751
DOI - 10.1113/jp280333
Subject(s) - medicine , heart failure , ejection fraction , stroke volume , cardiac output , cardiology , anesthesia , placebo , stroke (engine) , hemodynamics , mechanical engineering , alternative medicine , pathology , engineering
Key points Heart failure patients with reduced ejection fraction (HFrEF) exhibit severe limitations in exercise capacity ( V ̇ O 2peak). One of the primary peripheral mechanisms suggested to underlie exercise intolerance in HFrEF is excessive locomotor muscle group III/IV afferent feedback; however, this has never been investigated in human heart failure. HFrEF patients and controls performed an incremental exercise test to volitional exhaustion to determineV ̇ O 2peak with lumbar intrathecal fentanyl or placebo. During exercise, cardiac output, leg blood flow and radial artery and femoral venous blood gases were measured. With fentanyl, compared with placebo, patients with HFrEF achieved a higher peak workload,V ̇ O 2peak, cardiac output, stroke volume and leg blood flow. These findings suggest that locomotor muscle group III/IV afferent feedback in HFrEF leads to increased systemic vascular resistance, which constrains stroke volume, cardiac output and O 2 delivery thereby impairingV ̇ O 2peak and thus exercise capacity.Abstract To better understand the underlying mechanisms contributing to exercise limitation in heart failure with reduced ejection fraction (HFrEF), we investigated the influence of locomotor muscle group III/IV afferent inhibition via lumbar intrathecal fentanyl on peak exercise capacity ( V ̇ O 2peak) and the contributory mechanisms. Eleven HFrEF patients and eight healthy matched controls were recruited. The participants performed an incremental exercise test to volitional exhaustion to determineV ̇ O 2peak with lumbar intrathecal fentanyl or placebo. During exercise, cardiac output and leg blood flow ( Q ̇ L ) were measured via open‐circuit acetylene wash‐in technique and constant infusion thermodilution, respectively. Radial artery and femoral venous blood gases were measured.V ̇ O 2peak was 15% greater with fentanyl compared with placebo for HFrEF ( P < 0.01), while no different in the controls. During peak exercise with fentanyl, cardiac output was 12% greater in HFrEF secondary to significant decreases in systemic vascular resistance and increases in stroke volume compared with placebo (all, P < 0.01). From placebo to fentanyl, legV ̇ O 2 ,Q ̇ L and O 2 delivery were greater for HFrEF during peak exercise (all, P < 0.01), but not control. These findings indicate that locomotor muscle group III/IV afferent feedback in patients with HFrEF leads to increased systemic vascular resistance, which constrains stroke volume, cardiac output and O 2 delivery, thereby impairingV ̇ O 2peak and thus exercise capacity. These findings have important clinical implications asV ̇ O 2peak is highly predictive of morbidity and mortality in HF.