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Am J Physiol Heart Circ Physiol (August 19, 2004). doi:10.1152/ajpheart.00394.2004
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Submitted on April 27, 2004
Accepted on August 16, 2004

Renal Blood Flow in Heart Failure Patients During Exercise

Afsana Momen, Douglas Bower, John Boehmer, Allen R Kunselman, Urs A. Leuenberger, and Lawrence I. Sinoway*

* To whom correspondence should be addressed. E-mail: lsinoway{at}psu.edu.

During exercise reflex renal vasoconstriction maintains blood pressure and helps in redistributing blood flow to the contracting muscle. Exercise intolerance in heart failure (HF) is thought to involve diminished perfusion in active muscle. We studied the temporal relationship between static handgrip (HG) and renal blood flow velocity (RBV; duplex ultrasound) in 10 HF and in 9 matched controls during three muscle contraction paradigms. Fatiguing HG (protocol 1) at 40% of maximum voluntary contraction led to a greater reduction in RBV in HF as compared with controls (group main effect: P < .05). The reduction in RBV early in HG tended to be more prominent during the early phases of protocol 1. Similar RBV was observed in the two groups during post handgrip circulatory arrest (isolating muscle metaboreflex). Short bouts (15 s) of HG at graded intensities (protocol 2; engages muscle mechanoreflex and/or central command) led to greater reductions in RBV in HF than controls (P < .03). Protocol 3, voluntary and involuntary biceps contraction (eliminates central command) led to similar increases in renal vasoconstriction in HF (n = 4). Greater reductions in RBV were found in HF than in controls during the early phases of exercise. This effect was not likely due to a metaboreflex or central command. Thus, our data suggest that muscle mechanoreflex activity is enhanced in HF and serves to vigorously vasoconstrict the kidney. We believe this compensatory mechanism helps preserve blood flow to exercising muscle in HF.




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