Higher Work of Breathing During Exercise in Heart Failure With Preserved Ejection Fraction

Villarraga, Nicolas; Warner, Brit; Bruhn, Eric J.; Hammer, Shane M.; Bissen, Thomas G.; Olson, Thomas P.; Smith, Joshua R.

doi:10.1016/j.chest.2022.11.039

Cited by 3 publications

(3 citation statements)

References 46 publications

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“…In this context, chronic or intermittent alterations to the pulmonary system induced by congestion coupled with systemic abnormalities, result in ventilatory constraints during exercise contributing to exertional dyspnoea in HFpEF. 1,3 Patients with HFpEF also exhibit inspiratory muscle dysfunction with these patients having both decreased inspiratory muscle strength and endurance compared to healthy controls. 4 Importantly, nearly half of HFpEF patients exhibit inspiratory muscle weakness (IMW), which is associated with all-cause mortality.…”

Section: Inspiratory Muscle Strength Is Related To Exertional Dyspnoe...mentioning

confidence: 99%

“…It is now recognized that the pathophysiology of HFpEF involves multiple organ systems 2 with contributions from both central and peripheral mechanisms. In this context, chronic or intermittent alterations to the pulmonary system induced by congestion coupled with systemic abnormalities, result in ventilatory constraints during exercise contributing to exertional dyspnoea in HFpEF 1,3 . Patients with HFpEF also exhibit inspiratory muscle dysfunction with these patients having both decreased inspiratory muscle strength and endurance compared to healthy controls 4 .…”

Section: All Imw+ Imw− P‐valuementioning

confidence: 99%

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Inspiratory muscle strength is related to exertional dyspnoea in heart failure with preserved ejection fraction

Warner

Bruhn

Olson

et al. 2023

European J of Heart Fail

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Section: Inspiratory Muscle Strength Is Related To Exertional Dyspnoe...mentioning

confidence: 99%

Section: All Imw+ Imw− P‐valuementioning

confidence: 99%

Inspiratory muscle strength is related to exertional dyspnoea in heart failure with preserved ejection fraction

Warner

Bruhn

Olson

et al. 2023

European J of Heart Fail

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“…A recent study has reported that HFpEF patients have abnormal cardiovascular responses to isolated metaboreflex activation via post-exercise circulatory occlusion following forearm exercise compared with controls (Roberto et al, 2017). Recent studies have also found respiratory muscle and pulmonary system abnormalities in HFpEF patients including lower inspiratory muscle strength (which was related to higher exertional dyspnoea during low-intensity exercise), lower inspiratory muscle endurance, exaggerated cardiovascular responses to inspiratory muscle metaboreflex activation and higher work of breathing during exercise (Hammer et al, 2022;Villarraga et al, 2023;Warner et al, 2023). patients (e.g., Antunes-Correa et al, 2014;Chiappa et al, 2008;Piepoli et al, 1996;Smith & Taylor, 2022;Wang, Pan et al, 2010;Winkelmann et al, 2009).…”

Section: Summary and Future Directionsmentioning

confidence: 99%

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

Smith,

Senefeld,

Larson

et al. 2023

Experimental Physiology

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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 O2 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.

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Heart and Lungs in Heart Failure Is the Story of a Couple’s Uneasy Cohabitation in a One-Bedroom Apartment

Agostoni

Salvioni

2023

CHEST

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Higher Work of Breathing During Exercise in Heart Failure With Preserved Ejection Fraction

Cited by 3 publications

References 46 publications

Inspiratory muscle strength is related to exertional dyspnoea in heart failure with preserved ejection fraction

Inspiratory muscle strength is related to exertional dyspnoea in heart failure with preserved ejection fraction

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

Heart and Lungs in Heart Failure Is the Story of a Couple’s Uneasy Cohabitation in a One-Bedroom Apartment

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