Alpha 1-adrenergic-mediated vasoconstriction and functional sympatholysis in patients with heart failure with preserved ejection fraction

Abstract

Heart failure with preserved ejection fraction (HFpEF) is characterized by peripheral vascular dysregulation at both rest and during exercise. Prior studies have demonstrated that blood flow to skeletal muscle is closely regulated by sympathetic (α-adrenergic) vasoconstriction and the interaction of vasoactive substances released locally during exercise that counteract α-adrenergic vasoconstriction. This phenomenon, known as “functional sympatholysis” helps facilitate exercise hyperemia and has been shown to decline via aging and disease-related changes in α1-adrenergic function but this has not been studied in HFpEF. Thus, the overall objective of this study was to characterize peripheral α1-adrenergic vasoconstriction in HFpEF. We hypothesized that both resting α1-mediated vasoconstriction and the magnitude of functional sympatholysis would be diminished in HFpEF compared to healthy, age-matched control (CON) subjects.Six patients with HFpEF (3 male, 70±3 yrs) and six CON (3 male, 67±1 yrs) completed this study. Leg blood flow (LBF, ultrasound Doppler) was evaluated at rest and during dynamic single leg knee-extension exercise (0, 5 and 10 Watts) before and after local, intra-arterial administration of Phenylephrine (PE, α1-adrenergic agonist). PE-mediated changes in LBF (%Δ) at rest and during exercise were compared between groups. The magnitude of functional sympatholysis was calculated as the difference between PE-induced %Δ LBF from rest to exercise.At rest, the PE-induced %Δ LBF was smaller in HFpEF (HFpEF: -17±2% vs. CON: -31±8%, P=0.01). While PE-induced %Δ LBF were similar between groups during exercise, when these responses were compared to %Δ LBF at rest, the calculated magnitude of sympatholysis was significantly reduced in HFpEF (0W: -4±3%, 5W: -5±4%, 10W: -8±3%) compared to CON (0W: -17±7%, 5W: -20±8%, 10W: -25±6%). These data demonstrate a marked diminution in both α1-adrenergic responsiveness at rest and the ability to attenuate α1-adrenergic mediated vasoconstriction during exercise (functional sympatholysis) in patients with HFpEF. Diminished α1-adrenergic signaling and impaired functional sympatholysis may represent an important aspect of HFpEF pathophysiology that likely contribute to vascular dysregulation in this patient group. Funded in part by grants from the National Institutes of Health (T32HL139451) and the Veterans Health Administration (I01RX001311, IK2RX003670, IK2CX002114). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.