Resumen de The Mechanoreflex and Hemodynamic Response to Passive Leg Movement in Heart Failure.
Stephen J. Ives, D. Walter Wray, Markus Amann, Massimo Venturelli, Melissa A. H. Witman, H. Jonathan Groot, David E. Morgan, Josef Stehlik, Russell S. Richardson
AB Background: Sensitization of mechanosensitive afferents, which contribute to the exercise pressor reflex, has been recognized as a characteristic of patients with heart failure (HF); however, the hemodynamic implications of this hypersensitivity are unclear. Objectives: The present study used passive leg movement (PLM) and intrathecal injection of fentanyl to blunt the afferent portion of this reflex arc to better understand the role of the mechanoreflex on central and peripheral hemodynamics in HF. Methods: Femoral blood flow (FBF), mean arterial pressure, femoral vascular conductance, HR, stroke volume, cardiac output, ventilation, and muscle oxygenation of the vastus lateralis were assessed in 10 patients with New York Heart Association class II HF at baseline and during 3 min of PLM both with fentanyl and without (control). Results: Fentanyl had no effect on baseline measures but increased (control vs fentanyl, P < 0.05) the peak PLM-induced change in FBF (493 +/- 155 vs 804 +/- 198 [DELTA]mL[middle dot]min-1) and femoral vascular conductance (4.7 +/- 2 vs 8.5 +/- 3 [DELTA]mL[middle dot]min-1[middle dot]mm Hg-1) while norepinephrine spillover (103% +/- 19% vs 58% +/- 17%[DELTA]) and retrograde FBF (371 +/- 115 vs 260 +/- 68 [DELTA]mL[middle dot]min-1) tended to be reduced (P < 0.10). In addition, fentanyl administration resulted in greater PLM-induced increases in muscle oxygenation, suggestive of increased microvascular perfusion. Fentanyl had no effect on the ventilation, mean arterial pressure, HR, stroke volume, or cardiac output response to PLM. Conclusions: Although movement-induced central hemodynamics were unchanged by afferent blockade, peripheral hemodynamic responses were significantly enhanced. Thus, in patients with HF, a heightened mechanoreflex seems to augment peripheral sympathetic vasoconstriction in response to movement, a phenomenon that may contribute to exercise intolerance in this population
