Direct Assessment of Muscle Sympathetic Nerve Activity During Exercise in Heart Failure With Preserved Ejection Fraction: A Case Report

Abstract

Sympathetic overactivity, assessed via muscle sympathetic nerve activity (MSNA), is a hallmark characteristic of heart failure (HF) with reduced ejection fraction, 1 Notarius CF Atchison DJ Floras JS Impact of heart failure and exercise capacity on sympathetic response to handgrip exercise. Am J Physiol Heart Circ Physiol. 2001; 280: H969-H976 Crossref PubMed Google Scholar ,2 Seravalle G Quarti-Trevano F Dell'Oro R et al. Sympathetic and baroreflex alterations in congestive heart failure with preserved, midrange and reduced ejection fraction. J Hypertens. 2019; 37: 443-448 Crossref PubMed Scopus (22) Google Scholar a maladaptation that contributes to excess vasoconstriction, inappropriate increases in blood pressure (BP), and exercise intolerance. 1 Notarius CF Atchison DJ Floras JS Impact of heart failure and exercise capacity on sympathetic response to handgrip exercise. Am J Physiol Heart Circ Physiol. 2001; 280: H969-H976 Crossref PubMed Google Scholar ,3 Notarius CF Millar PJ Murai H et al. Divergent muscle sympathetic responses to dynamic leg exercise in heart failure and age-matched healthy subjects. J Physiol. 2015; 593: 715-722 Crossref PubMed Scopus (34) Google Scholar Conversely, despite initial evidence for increased risk of cardiac events in patients with HF with preserved ejection fraction (HFpEF) who exhibit cardiac sympathetic overactivity, 4 Katoh S Shishido T Kutsuzawa D et al. Iodine-123-metaiodobenzylguanidine imaging can predict future cardiac events in heart failure patients with preserved ejection fraction. Ann Nuclear Med. 2010; 24: 679-686 Crossref PubMed Scopus (32) Google Scholar few studies have directly assessed MSNA in this patient group, 2 Seravalle G Quarti-Trevano F Dell'Oro R et al. Sympathetic and baroreflex alterations in congestive heart failure with preserved, midrange and reduced ejection fraction. J Hypertens. 2019; 37: 443-448 Crossref PubMed Scopus (22) Google Scholar ,5 Tokuhisa H Murai H Okabe Y et al. Differential effects of lipophilic and hydrophilic statins on muscle sympathetic nerve activity in heart failure with preserved left ventricular ejection fraction. Auton Neurosci. 2018; 213: 8-14 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar and none have evaluated both MSNA and BP responses to sympathoexcitatory maneuvers. Importantly, alterations (both blunted and exaggerated) in cardiovascular reactivity have been associated with poor health outcomes in several populations. 6 Kupper N Denollet J Widdershoven J et al. Cardiovascular reactivity to mental stress and mortality in patients with heart failure. JACC Heart Fail. 2015; 3: 373-382 Crossref PubMed Scopus (21) Google Scholar -7 Simoes GM Campagnaro BP Tonini CL et al. Hemodynamic reactivity to laboratory stressors in healthy subjects: influence of gender and family history of cardiovascular diseases. Int J Med Sci. 2013; 10: 848-856 Crossref PubMed Scopus (9) Google Scholar , 8 Souza GG Mendonca-de-Souza AC Duarte AF et al. Blunted cardiac reactivity to psychological stress associated with higher trait anxiety: a study in peacekeepers. BMC Neurosci. 2015; 16: 81 Crossref PubMed Scopus (11) Google Scholar Herein, we report for the first time the direct assessment of MSNA in response to isometric handgrip exercise (HG), a sympathoexcitatory maneuver, in a patient with HFpEF and a healthy control of similar age.