Comparative effects of vasodilating stimuli on limb arterial blood flow in patients with congestive heart failure

Background The underlying pathophysiology of heart failure with preserved ejection fraction (HFpEF) remains poorly understood. Changes in peripheral arterial function concomitantly with the evaluation of cardiopulmonary reserve and biomarkers related to wall stress, extra-cellular matrix turnover (ECM), subclinical inflammation and oxidative stress have not been investigated in patients with HFpEF nor compared with age-matched healthy volunteers (HV). We hypothesized that patients with HFpEF would have impairments in cardiac reserve with reduced peripheral arterial function associated with broad-spectrum biomarkers activation. Methods Eighteen male and female HFpEF patients (aged 70 ± 9 yr) NYHA class II and III were recruited. Data from patients were compared with those from 14 age and sex matched HV. A maximal exercise testing with gas exchange analysis was completed on a treadmill using a RAMP protocol and heart rate recovery (HRR) was measured at 1 and 2 minutes following exercise. Peripheral arterial function was assessed using near infrared radionuclide plethysmography. Biomarkers included BNP, NT-proBNP, hsCRP, TBARS, 8-epi-prostaglandin F2α, MMP 1, 2, 9 and TIMP 1, 2, 3, 4) were analyzed. Results Selected data are presented in the Table 1 and 2. Conclusions Compared to healthy volunteers, patients with HFpEF demonstrated a significant decrease in aerobic capacity but an increase in basal peripheral arterial blood flow, subclinical inflammation and oxidative stress. The increase in resting arterial blood flow may be a compensatory mechanism for the decrease in cardiac reserve and the pro-inflammatory/oxidant milieu in these patients.

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Alterations in diaphragm strength and fatiguability in congestive heart failure

Journal of Applied Physiology ◽

10.1152/jappl.1994.76.6.2707 ◽

1994 ◽

Vol 76 (6) ◽

pp. 2707-2713 ◽

Cited By ~ 40

Author(s):

G. Supinski ◽

A. DiMarco ◽

M. Dibner-Dunlap

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Arterial Occlusion ◽

Arterial Blood Flow ◽

Exercise Intolerance ◽

Diaphragmatic Function ◽

Arterial Blood ◽

Phrenic Artery ◽

Acute Study ◽

Rapid Ventricular Pacing

Recent reports suggested that exercise intolerance associated with congestive heart failure (CHF) may be due to changes in peripheral limb muscle function. Our purpose was to determine whether CHF also elicits alterations in diaphragmatic function. CHF was induced in dogs by rapid ventricular pacing for a period of 4–6 wk. After signs of CHF developed, dogs were anesthetized and an acute study was performed to assess diaphragm function. Diaphragm strips were dissected in situ in the left costal diaphragm, the phrenic artery supplying these strips was cannulated, and strips were perfused with arterial blood at arteriovenous pressure gradient of 90 mmHg. Diaphragm strength and fatiguability were then determined, and phrenic flow response to transient arterial occlusion was assessed. A group of nonpaced normal dogs was similarly studied and served as controls. We found that CHF dogs had a significant reduction in diaphragm strength. For example, tetanic force in response to 100 Hz of stimulation was 25.5 +/- 1.0 N/cm2 in control dogs but only 19.6 +/- 1.9 kg/cm2 in CHF dogs (P < 0.02). In addition, CHF dogs had increased diaphragm fatiguability. Diaphragm force fell to 27 +/- 3% of its baseline value during a 30-min fatigue trial in CHF dogs but only to 44 +/- 4% in control dogs (P < 0.01). CHF dogs also had a altered phrenic arterial hyperemic response to arterial occlusion and a reduction in phrenic arterial blood flow achieved during the fatigue trial. We conclude that development of CHF is associated with significant alterations in diaphragmatic function, causing a marked increase in fatiguability.

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400 Exercise capacity, peripherial arterial blood flow and endothelium-dependent vasodilation under long-term carvedilol treatment in chronic heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(05)80243-7 ◽

2005 ◽

Vol 4 (1) ◽

pp. 89-89

Keyword(s):

Heart Failure ◽

Blood Flow ◽

Chronic Heart Failure ◽

Exercise Capacity ◽

Arterial Blood Flow ◽

Arterial Blood

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Reduced peripheral arterial blood flow with preserved cardiac output during submaximal bicycle exercise in elderly heart failure

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-11-48 ◽

2009 ◽

Vol 11 (1) ◽

pp. 48 ◽

Cited By ~ 23

Author(s):

Chirapa Puntawangkoon ◽

Dalane W Kitzman ◽

Stephen B Kritchevsky ◽

Craig A Hamilton ◽

Barbara Nicklas ◽

...

Keyword(s):

Heart Failure ◽

Blood Flow ◽

Cardiac Output ◽

Arterial Blood Flow ◽

Bicycle Exercise ◽

Arterial Blood ◽

Peripheral Arterial

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Changes in Cardiopulmonary Reserve and Peripheral Arterial Function Concomitantly with Subclinical Inflammation and Oxidative Stress in Patients with Heart Failure with Preserved Ejection Fraction

International Journal of Vascular Medicine ◽

10.1155/2014/917271 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Damien Vitiello ◽

François Harel ◽

Rhian M. Touyz ◽

Martin G. Sirois ◽

Joel Lavoie ◽

...

Keyword(s):

Oxidative Stress ◽

Heart Failure ◽

Blood Flow ◽

Ejection Fraction ◽

Arterial Blood Flow ◽

Preserved Ejection Fraction ◽

Arterial Blood ◽

Patients With Heart Failure ◽

Peripheral Arterial ◽

And Oxidative Stress

Background. Changes in cardiopulmonary reserve and biomarkers related to wall stress, inflammation, and oxidative stress concomitantly with the evaluation of peripheral arterial blood flow have not been investigated in patients with heart failure with preserved ejection fraction (HFpEF) compared with healthy subjects (CTL).Methods and Results. Eighteen HFpEF patients and 14 CTL were recruited. Plasma levels of inflammatory and oxidative stress biomarkers were measured at rest. Brain natriuretic peptide (BNP) was measured at rest and peak exercise. Cardiopulmonary reserve was assessed using an exercise protocol with gas exchange analyses. Peripheral arterial blood flow was determined by strain gauge plethysmography. Peak VO2(12.0±0.4versus19.1±1.1 mL/min/kg,P<0.001) and oxygen uptake efficiency slope (1.55±0.12versus2.06±0.14,P<0.05) were significantly decreased in HFpEF patients compared with CTL. BNP at rest and following stress, C-reactive-protein, interleukin-6, and TBARS were significantly elevated in HFpEF. Both basal and posthyperemic arterial blood flow were not significantly different between the HFpEF patients and CTL.Conclusions. HFpEF exhibits a severe reduction in cardiopulmonary reserve and oxygen uptake efficiency concomitantly with an elevation in a broad spectrum of biomarkers confirming an inflammatory and prooxidative status in patients with HFpEF.

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