(Circulation. 2003;108:1126.)
© 2003 American Heart Association, Inc.
Basic Science Reports |
From the Departments of Internal Medicine (S.A.S., P.P.A.M., J.H.M., M.G.G.) and Physiology (J.H.M.), Harry S. Moss Heart Center, and Department of Health Care Sciences (S.A.S.), University of Texas Southwestern Medical Center, Dallas, Tex.
Correspondence to Mary G. Garry, PhD, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9174. E-mail mary.garry{at}utsouthwestern.edu
Received December 23, 2002; de novo received March 18, 2003; accepted May 1, 2003.
Background In heart failure, there is a sympathetically mediated hyperkinetic cardiovascular response to exercise that limits tolerance to physical activity. Alterations in skeletal muscle morphology and metabolism have led to the hypothesis that the exercise pressor reflex (EPR) becomes hyperactive after the development of cardiomyopathy and contributes to the exaggerated circulatory response elicited.
Methods and Results To test this hypothesis, Sprague-Dawley rats were divided into the following groups: control, sham, and dilated cardiomyopathy (DCM, induced by ischemic injury). Using transthoracic echocardiography, left ventricular fractional shortening was 47±2%, 44±1%, and 24±2% in control, sham, and DCM rats, respectively. Activation of the EPR by electrically induced static muscle contraction resulted in significantly larger increases in mean arterial pressure and heart rate in DCM animals (32±2 mm Hg, 13±1 bpm) compared with control (20±1 mm Hg, 8±1 bpm) and sham (20±2 mm Hg, 8±1 bpm) rats. Comparable results were obtained with selective stimulation of the mechanically sensitive component of the EPR by passive muscle stretch. The augmentations in EPR and mechanoreflex activity in DCM occurred progressively over a 10-week period, becoming greater as the severity of left ventricular dysfunction increased.
Conclusions In DCM, the potentiated cardiovascular response to static muscle contraction is mediated, in part, by an exaggerated EPR. The muscle mechanoreflex contributes significantly to the EPR dysfunction that develops.
Key Words: afferent heart failure hemodynamics nervous system, autonomic exercise
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