Circulation, Vol 74, 245-251, Copyright © 1986 by American Heart Association
TH LeJemtel, CS Maskin, D Lucido and BJ Chadwick
Lower limb blood flow, oxygen uptake, and femoral vein O2 content were
measured at rest and during maximal bicycle exercise, performed with two
legs and one leg, in four normal subjects and in five patients with severe
congestive heart failure. While in normal subjects femoral vein blood flow
and lower limb vascular conductance were significantly greater during
one-leg exercise than during two-leg exercise (6084 +/- 745 vs 5370 +/- 803
ml/min, p less than .05, and 52.3 +/- 8.0 vs 45.1 +/- 8.2 U X 10(3), p less
than .05, respectively), in patients with severe congestive heart failure
these values were similar during the two forms of exercise (1082 +/- 459 vs
1053 +/- 479 ml/min and 9.6 +/- 3.7 vs 9.4 +/- 3.5 U X 10(3),
respectively). In five additional patients, one-leg maximal bicycle
exercise was performed before and after administration of phentolamine into
the femoral artery of the active leg. Regional alpha-adrenergic blockade
with phentolamine did not alter maximal oxygen uptake attained during
one-leg bicycle exercise (9.8 +/- 1.5 vs 10.3 +/- 1.9 ml/kg). Lower limb
blood flow and femoral vein O2 content attained during maximal one-leg
exercise were also similar before and after phentolamine. Thus, in contrast
with normal subjects, patients with severe congestive heart failure were
unable to further increase limb blood flow during one-leg bicycle exercise.
Moreover, local alpha-adrenergic blockade does not augment blood flow to
the active limb during maximal one-leg bicycle exercise. This suggests that
the ability of the muscular vasculature to vasodilate during exercise is
impaired and may be a limiting factor to maximal exercise capacity in such
patients.
ARTICLES
Failure to augment maximal limb blood flow in response to one-leg versus two-leg exercise in patients with severe heart failure
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