Circulation, Vol 80, 769-781, Copyright © 1989 by American Heart Association
MJ Sullivan, JD Knight, MB Higginbotham and FR Cobb
We studied the central hemodynamic, leg blood flow, and metabolic responses
to maximal upright bicycle exercise in 30 patients with chronic heart
failure attributable to severe left ventricular dysfunction (ejection
fraction, 24 +/- 8%) and in 12 normal subjects. At peak exercise, patients
demonstrated reduced oxygen consumption (15.1 +/- 4.8 vs. 32.1 +/- 9.9
ml/kg/min, p less than 0.001), cardiac output (8.7 +/- 3.2 vs. 18.6 +/- 4.4
l/min, p less than 0.001), and mean systemic arterial blood pressure (116
+/- 15 vs. 135 +/- 13 mm Hg, p less than 0.01) compared with normal
subjects. Leg blood flow was decreased in patients versus normal subjects
at rest and matched submaximal work rates and maximal exercise (2.1 +/- 1.9
vs. 6.4 +/- 1.4 l/min, all p less than 0.01). Mean systemic arterial blood
pressure was no different in the two groups at rest or at matched
submaximal work rates, whereas leg vascular resistance was higher in
patients compared with normal subjects at rest, submaximal, and maximal
exercise (all p less than 0.01). Although nonleg blood flow was decreased
at rest in patients, it did not decrease significantly during exercise in
either group. Peak exercise leg blood flow was related to peak exercise
cardiac output in patients (r = 0.66, p less than 0.01) and normal subjects
(r = 0.67, p less than 0.01). In patients, leg vascular resistance was not
related to mean arterial blood pressure, pulmonary capillary wedge
pressure, arterial catecholamines, arterial lactate, or femoral venous pH
at rest or during exercise. Compared with normal subjects during submaximal
exercise, patients demonstrated increased leg oxygen extraction and lactate
production accompanied by decreased leg oxygen consumption. Thus, in
patients with chronic heart failure compared with normal subjects, skeletal
muscle perfusion is decreased at rest and during submaximal and maximal
exercise, and local vascular resistance is increased. Our data indicate
that nonleg blood flow and arterial blood pressure were preferentially
maintained during exercise at the expense of leg hypoperfusion in our
patients. This was associated with decreased leg oxygen utilization and
increased leg oxygen extraction when compared to normal subjects, providing
further evidence that reduced perfusion of skeletal muscle is important in
causing early anaerobic skeletal muscle metabolism during exercise in
subjects with this disorder.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure. Muscle blood flow is reduced with maintenance of arterial perfusion pressure
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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