1 From the Laboratory of Clinical Physiology, Cardiology Section, University of California at Davis, School of Medicine, Davis, California.
Patients with severe congestive heart failure (CHF) have been found to have a diminished response to the metabolic arteriolar dilator stimulus of ischemia. In order to evaluate a more physiologic stimulus and the possible metabolic consequences of this vascular abnormality, 22 normal subjects (N) and seven patients with severe CHF performed rhythmic forearm exercise by squeezing a rubber bulb to 25, 50, or 100 mm Hg for 5 sec, four times/min, for 5 min. During the last half of the 10 sec relaxation phases, forearm blood flow (FBF) was measured plethysmographically. Not only was FBF reduced at rest in CHF (CHF:2.00 ± 0.31; N: 3.10 ± 0.27 ml/min·100 ml, P < 0.02) but it was reduced at each level of exercise as well (CHF: 4.05 ± 0.71, 5.57 ± 0.71, 6.68 ± 3.09; N: 7.10 ± 0.76, 11.15 ± 1.24, 20.32 ± 1.93 ml/min·100 ml, P < 0.01). Forearm oxygen extraction, calculated from brachial venous and systemic arterial blood, was consistently increased in CHF and was sufficient to maintain a normal forearm oxygen consumption at rest (CHF: 0.14 ± 0.04; N: 0.12 ± 0.01 ml O2/min · 100 ml, P < 0.5). During exercise the calculated index of oxygen consumption was reduced at all levels of exercise (CHF: 0.30 ± 0.04, 0.48 ± 0.09, 0.54 ± 0.14; N: 0.51 ± 0.05, 0.89 ± 0.08, 1.63 ± 0.13 ml O2/min · 100 ml, P < 0.01). These differences persisted despite alpha-adrenergic blockade with phentolamine and suppression of skin flow in N by epinephrine iontophoresis. Therefore, at comparable levels of dynamic forearm exercise patients with CHF have an inadequate arteriolar dilation and their augmented oxygen extraction is not sufficient to prevent them from shifting more completely to anaerobic metabolism.
Submitted on December 26, 1973
© 1974 American Heart Association, Inc.
A Comparison of Regional Blood Flow and Oxygen Utilization During Dynamic Forearm Exercise in Normal Subjects and Patients with Congestive Heart Failure
Key Words: Arteriolar dilatation • Plethysmography • Forearm blood flow • Hyperemia • Forearm oxygen consumption • Congestive heart failure • Alpha-adrenergic tone • Exercise
Accepted on March 12, 1974
This article has been cited by other articles:
 |
|
 |
|
  S. Koba, Z. Gao, and L. I. Sinoway Oxidative stress and the muscle reflex in heart failure J. Physiol., November 1, 2009; 587(21): 5227 - 5237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Sperandio, A. Borghi-Silva, A. Barroco, L. E. Nery, D. R. Almeida, and J. A. Neder Microvascular oxygen delivery-to-utilization mismatch at the onset of heavy-intensity exercise in optimally treated patients with CHF Am J Physiol Heart Circ Physiol, November 1, 2009; 297(5): H1720 - H1728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Koba, J. Xing, L. I. Sinoway, and J. Li Sympathetic nerve responses to muscle contraction and stretch in ischemic heart failure Am J Physiol Heart Circ Physiol, January 1, 2008; 294(1): H311 - H321. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Behnke, M. D. Delp, D. C. Poole, and T. I. Musch Aging potentiates the effect of congestive heart failure on muscle microvascular oxygenation J Appl Physiol, November 1, 2007; 103(5): 1757 - 1763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Xing, S. Koba, V. Kehoe, Z. Gao, K. Rice, N. King, L. Sinoway, and J. Li Interstitial norepinephrine concentrations in skeletal muscle of ischemic heart failure Am J Physiol Heart Circ Physiol, August 1, 2007; 293(2): H1190 - H1195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Momen, D. Bower, J. Boehmer, A. R. Kunselman, U. A. Leuenberger, and L. I. Sinoway Renal blood flow in heart failure patients during exercise Am J Physiol Heart Circ Physiol, December 1, 2004; 287(6): H2834 - H2839. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. E. Richardson, C. A. Kindig, T. I. Musch, and D. C. Poole Effects of chronic heart failure on skeletal muscle capillary hemodynamics at rest and during contractions J Appl Physiol, September 1, 2003; 95(3): 1055 - 1062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kemppainen, H. Tsuchida, K. Stolen, H. Karlsson, M. Bjornholm, O. J Heinonen, P. Nuutila, A. Krook, J. Knuuti, and J. R Zierath Insulin signalling and resistance in patients with chronic heart failure J. Physiol., July 1, 2003; 550(1): 305 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. L. Pina, C. S. Apstein, G. J. Balady, R. Belardinelli, B. R. Chaitman, B. D. Duscha, B. J. Fletcher, J. L. Fleg, J. N. Myers, and M. J. Sullivan Exercise and Heart Failure: A Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention Circulation, March 4, 2003; 107(8): 1210 - 1225. [Full Text] [PDF]
|
|
|
|
 |
|
 W A Parsonage, D Hetmanski, and A J Cowley Beneficial haemodynamic effects of insulin in chronic heart failure Heart, May 1, 2001; 85(5): 508 - 513. [Abstract] [Full Text]
|
|
|
|
 |
|
 D Harrington, S.D Anker, and A.J.S Coats Preservation of exercise capacity and lack of peripheral changes in asymptomatic patients with severely impaired left ventricular function Eur. Heart J., March 1, 2001; 22(5): 392 - 399. [Abstract] [PDF]
|
|
|
|
|
|
D. M. Kaye, B. A. Ahlers, D. J. Autelitano, and J. P. F. Chin-Dusting In Vivo and In Vitro Evidence for Impaired Arginine Transport in Human Heart Failure Circulation, November 28, 2000; 102(22): 2707 - 2712. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Katz, C. Maskin, G. Jondeau, T. Cocke, R. Berkowitz, and T. LeJemtel Near-maximal fractional oxygen extraction by active skeletal muscle in patients with chronic heart failure J Appl Physiol, June 1, 2000; 88(6): 2138 - 2142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Hambrecht, L. Hilbrich, S. Erbs, S. Gielen, E. Fiehn, N. Schoene, and G. Schuler Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral L-arginine supplementation J. Am. Coll. Cardiol., March 1, 2000; 35(3): 706 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Shoemaker, H. L. Naylor, C. S. Hogeman, and L. I. Sinoway Blood Flow Dynamics in Heart Failure Circulation, June 15, 1999; 99(23): 3002 - 3008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y Kanaya, M Nakamura, N Kobayashi, and K Hiramori Effects of L-arginine on lower limb vasodilator reserve and exercise capacity in patients with chronic heart failure Heart, May 1, 1999; 81(5): 512 - 517. [Abstract] [Full Text]
|
|
|
|
|
|
J. K. Shoemaker, A. R. Kunselman, D. H. Silber, and L. I. Sinoway Maintained exercise pressor response in heart failure J Appl Physiol, November 1, 1998; 85(5): 1793 - 1799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Thomas, O. Hudlicka, M. D. Brown, and D. Deveci Alterations in small arterioles precede changes in limb skeletal muscle after myocardial infarction Am J Physiol Heart Circ Physiol, September 1, 1998; 275(3): H1032 - H1039. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann and G. Heusch Myocardial, skeletal muscle, and renal blood flow during exercise in conscious dogs with heart failure Am J Physiol Heart Circ Physiol, November 1, 1997; 273(5): H2452 - H2457. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. S. Rector, A. J. Bank, K. A. Mullen, L. K. Tschumperlin, R. Sih, K. Pillai, and S. H. Kubo Randomized, Double-Blind, Placebo-Controlled Study of Supplemental Oral L-Arginine in Patients With Heart Failure Circulation, June 15, 1996; 93(12): 2135 - 2141. [Abstract] [Full Text]
|
|
|
|
|
|
M. Piepoli, A. L. Clark, M. Volterrani, S. Adamopoulos, P. Sleight, and A. J.S. Coats Contribution of Muscle Afferents to the Hemodynamic, Autonomic, and Ventilatory Responses to Exercise in Patients With Chronic Heart Failure : Effects of Physical Training Circulation, March 1, 1996; 93(5): 940 - 952. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. Myers and V. F. Froelicher Hemodynamic Determinants of Exercise Capacity in Chronic Heart Failure Ann Intern Med, September 1, 1991; 115(5): 377 - 386. [Abstract] [PDF]
|
|
|
|
 |
|
 F. Bellandi, M. De Scalzi, V. de Leonardis, L. Arena, B. Belli, S. Barbagli, G. Morace, P. Cinelli, and G. Morace Muscular Blood Flow in Patients with Heart Failure Angiology, August 1, 1986; 37(9): 658 - 662. [Abstract] [PDF]
|
|
|
|
 |
|
 S. A. Rubin and H. J. C. Swan Vasodilator Therapy for Heart Failure: Concepts, Applications, and Challenges JAMA, February 20, 1981; 245(7): 761 - 763. [Abstract] [PDF]
|
|