Consequences of group III/IV afferent feedback and respiratory muscle work on exercise tolerance in heart failure with reduced ejection fraction.

Autor: Smith JR; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Senefeld JW; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA., Larson KF; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Joyner MJ; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Jazyk: angličtina
Zdroj: Experimental physiology [Exp Physiol] 2023 Nov; Vol. 108 (11), pp. 1351-1365. Date of Electronic Publication: 2023 Sep 21.
DOI: 10.1113/EP090755
Abstrakt: Exercise intolerance and exertional dyspnoea are the cardinal symptoms of heart failure with reduced ejection fraction (HFrEF). In HFrEF, abnormal autonomic and cardiopulmonary responses arising from locomotor muscle group III/IV afferent feedback is one of the primary mechanisms contributing to exercise intolerance. HFrEF patients also have pulmonary system and respiratory muscle abnormalities that impair exercise tolerance. Thus, the primary impetus for this review was to describe the mechanistic consequences of locomotor muscle group III/IV afferent feedback and respiratory muscle work in HFrEF. To address this, we first discuss the abnormal autonomic and cardiopulmonary responses mediated by locomotor muscle afferent feedback in HFrEF. Next, we outline how respiratory muscle work impairs exercise tolerance in HFrEF through its effects on locomotor muscle O 2 delivery. We then discuss the direct and indirect evidence supporting an interaction between locomotor muscle group III/IV afferent feedback and respiratory muscle work during exercise in HFrEF. Last, we outline future research directions related to locomotor and respiratory muscle abnormalities to progress the field forward in understanding the pathophysiology of exercise intolerance in HFrEF. NEW FINDINGS: What is the topic of this review? This review is focused on understanding the role that locomotor muscle group III/IV afferent feedback and respiratory muscle work play in the pathophysiology of exercise intolerance in patients with heart failure. What advances does it highlight? This review proposes that the concomitant effects of locomotor muscle afferent feedback and respiratory muscle work worsen exercise tolerance and exacerbate exertional dyspnoea in patients with heart failure.
(© 2023 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)
Databáze: MEDLINE
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