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Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction.

Publication ,  Journal Article
Borlaug, BA; Melenovsky, V; Russell, SD; Kessler, K; Pacak, K; Becker, LC; Kass, DA
Published in: Circulation
November 14, 2006

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 of left ventricular hypertrophy underwent maximal-effort upright cycle ergometry with radionuclide ventriculography to determine rest and exercise cardiovascular function. Resting cardiovascular function was similar between the 2 groups. Both had limited exercise capacity, but this was more profoundly reduced in HFpEF patients (exercise duration 180+/-71 versus 455+/-184 seconds; peak oxygen consumption 9.0+/-3.4 versus 14.4+/-3.4 mL x kg(-1) x min(-1); both P<0.001). At matched low-level workload, HFpEF subjects displayed approximately 40% less of an increase in heart rate and cardiac output and less systemic vasodilation (all P<0.05) despite a similar rise in end-diastolic volume, stroke volume, and contractility. Heart rate recovery after exercise was also significantly delayed in HFpEF patients. Exercise capacity correlated with the change in cardiac output, heart rate, and vascular resistance but not end-diastolic volume or stroke volume. Lung blood volume and plasma norepinephrine levels rose similarly with exercise in both groups. CONCLUSIONS: HFpEF patients have reduced chronotropic, vasodilator, and cardiac output reserve during exercise compared with matched subjects with hypertensive cardiac hypertrophy. These limitations cannot be ascribed to diastolic abnormalities per se and may provide novel therapeutic targets for interventions to improve exercise capacity in this disorder.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

November 14, 2006

Volume

114

Issue

20

Start / End Page

2138 / 2147

Location

United States

Related Subject Headings

  • Vasodilation
  • Stroke Volume
  • Pulmonary Circulation
  • Physical Endurance
  • Norepinephrine
  • Middle Aged
  • Male
  • Humans
  • Heart Rate
  • Female
 

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Borlaug, B. A., Melenovsky, V., Russell, S. D., Kessler, K., Pacak, K., Becker, L. C., & Kass, D. A. (2006). Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation, 114(20), 2138–2147. https://doi.org/10.1161/CIRCULATIONAHA.106.632745
Borlaug, Barry A., Vojtech Melenovsky, Stuart D. Russell, Kristy Kessler, Karel Pacak, Lewis C. Becker, and David A. Kass. “Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction.Circulation 114, no. 20 (November 14, 2006): 2138–47. https://doi.org/10.1161/CIRCULATIONAHA.106.632745.
Borlaug BA, Melenovsky V, Russell SD, Kessler K, Pacak K, Becker LC, et al. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006 Nov 14;114(20):2138–47.
Borlaug, Barry A., et al. “Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction.Circulation, vol. 114, no. 20, Nov. 2006, pp. 2138–47. Pubmed, doi:10.1161/CIRCULATIONAHA.106.632745.
Borlaug BA, Melenovsky V, Russell SD, Kessler K, Pacak K, Becker LC, Kass DA. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006 Nov 14;114(20):2138–2147.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

November 14, 2006

Volume

114

Issue

20

Start / End Page

2138 / 2147

Location

United States

Related Subject Headings

  • Vasodilation
  • Stroke Volume
  • Pulmonary Circulation
  • Physical Endurance
  • Norepinephrine
  • Middle Aged
  • Male
  • Humans
  • Heart Rate
  • Female