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Division of Cardiology, Toronto General and Mount Sinai Hospitals, University of Toronto, Toronto, Ontario M5G 1X5, Canada
Peak oxygen uptake
(
O2 peak) in patients with heart
failure (HF) is inversely related to muscle sympathetic nerve activity
(MSNA) at rest. We hypothesized that the MSNA response to handgrip
exercise is augmented in HF patients and is greatest in those with low
O2 peak. We studied 14 HF patients and
10 age-matched normal subjects during isometric [30% of maximal voluntary contraction (MVC)] and isotonic (10%, 30%, and 50% MVC) handgrip exercise that was followed by 2 min of posthandgrip
ischemia (PHGI). MSNA was significantly increased during
exercise in HF but not normal subjects. Both MSNA and HF levels
remained significantly elevated during PHGI after 30% isometric and
50% isotonic handgrip in HF but not normal subjects. HF patients with
lower O2 peak (<56% predicted;
n = 8) had significantly higher MSNA during rest and
exercise than patients with
O2 peak > 56% predicted (n = 6) and normal subjects. The muscle metaboreflex
contributes to the greater reflex increase in MSNA during
ischemic or intense nonischemic exercise in HF. This
occurs at a lower threshold than normal and is a function of
O2 peak.
muscle sympathetic nerve activity; metaboreflex; O2 peak; left ventricular dysfunction; ischemia
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