Redistribution of blood flow during exercise is impaired in heart failure with preserved ejection fraction

Abstract

Exercise intolerance is a cardinal symptom in heart failure with preserved ejection fraction (HFpEF). The underlying pathophysiological mechanisms of HFpEF and their influence on exercise intolerance remains poorly understood. This study investigated the role of re-distribution of blood flow in modulating the increase in hindlimb muscle blood flow during HFpEF.We proposed that exercise intolerance is partially contributed by an impaired ability to divert blood flow from peripheral organs such as the kidney during exercise. We utilised an ovine model of HFpEF in which hypertension was established in aged female sheep. We then examined the mean arterial pressure, heart rate, cardiac output, renal blood flow and hindlimb blood flow response to treadmill exercise in both groups of conscious animals.Animals with HFpEF had elevated left ventricular end diastolic pressures (13 ± 6 vs. 0 ± 1 mmHg, p<0.05) as well as enlarged cardiomyocytes compared to normotensive controls. Exercise in the control animals led to increases in cardiac output and heart rate. These responses were significantly attenuated in HFpEF (increase of 4.5 ± 1 vs. 8 ± 1 L/min, p<0.05) and heart rate (increase of 32 ± 3 vs. 41 ± 4 bpm, p<0.05). In a separate group of instrumented animals, the increase in blood flow to the hindlimb vasculature was attenuated in the HFpEF animals compared to control animals (increase of 2 ± 1 vs. 4 ± 2 L/min, p<0.05). There was a reduction in renal blood flow in the control animals (-150 ± 50 ml/min) and this change was reversed to an increase in the HFpEF animals (+50 ± 20 ml/min).Our results suggest that the exercise intolerance observed in our ovine model of HFpEF may in part be due to an impaired ability to regulate blood flow to the kidney and hindlimb muscles during exercise. RR gratefully acknowledges granting support from the Health Research Council of New Zealand, the University of Auckland Faculty Research Development Fund and the National Heart Foundation of New Zealand. 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.