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(Circulation. 1999;99:3002-3008.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Blood Flow Dynamics in Heart Failure

J. Kevin Shoemaker, PhD; Heather L. Naylor, BSc; Cynthia S. Hogeman, BA, BSN; Lawrence I. Sinoway, MD

From the Department of Medicine, Section of Cardiology, Pennsylvania State University College of Medicine, Hershey, Pa (J.K.S., C.S.H., L.I.S.); Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada (H.L.N.); and Lebanon VA Medical Center, Lebanon, Pa (L.I.S.).

Correspondence to J. Kevin Shoemaker, PhD, Section of Cardiology, MC H047, Pennsylvania State University College of Medicine, 500 University Dr, PO Box 850, Hershey, PA 17033. E-mail kshoemak{at}gcrc.hmc.psghs.edu

Background—Exercise intolerance in heart failure (HF) may be due to inadequate vasodilation, augmented vasoconstriction, and/or altered muscle metabolic responses that lead to fatigue.

Methods and Results—Vascular and metabolic responses to rhythmic forearm exercise were tested in 9 HF patients and 9 control subjects (CTL) during 2 protocols designed to examine the effect of HF on the time course of oxygen delivery versus uptake (protocol 1) and on vasoconstriction during exercise with 50 mm Hg pressure about the forearm to evoke a metaboreflex (protocol 2). In protocol 1, venous lactate and H⁺ were greater at 4 minutes of exercise in HF versus CTL (P<0.05) despite similar blood flow and oxygen uptake responses. In protocol 2, mean arterial pressure increased similarly in each group during ischemic exercise. In CTL, forearm blood flow and vascular conductance were similar at the end of ischemic and ambient exercise. In HF, forearm blood flow and vascular conductance were reduced during ischemic exercise compared with the ambient trial.

Conclusions—Intrinsic differences in skeletal muscle metabolism, not vasodilatory dynamics, must account for the augmented glycolytic metabolic responses to moderate-intensity exercise in class II and III HF. The inability to increase forearm vascular conductance during ischemic handgrip exercise, despite a normal pressor response, suggests that enhanced vasoconstriction of strenuously exercising skeletal muscle contributes to exertional fatigue in HF.

Key Words: vasodilation • vasoconstriction • oxygen • exercise • heart failure

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