Is vascular remodelling in patients with chronic heart failure exaggerated?

Different effects of mechano- and metaboreflex on the central blood pressure waveform

Introduction

The effect of mechanoreflex on central blood pressure (BP) is unclear, although the influence of metaboreflex has been investigated. A relatively small contribution of the mechanoreflex to the pressor response to exercise has been considered in humans because many studies have failed to isolate the mechanoreflex-mediated pressor response. In a recent study, we successfully isolated a mechanoreflex-mediated pressor response using static passive stretching (SPS) in the forearm. Thus, it is possible to isolate the effect of the mechanoreflex on the central BP using this recently developed method. We investigated the effect of muscle mechanoreflex on central BP and compared the changes in the shape of the central BP waveform during mechanoreflex and metaboreflex.

Methods

We measured 12 healthy males (age, 26 ± 2 years; height, 171.1 ± 5.2 cm; body mass, 63.3 ± 10.3 kg; body fat, 16.7% ± 3.9%; means ± standard deviation [SD]) in this study. All participants performed static passive stretching (SPS) of the forearm for 60 s to isolate the muscle mechanoreflex. They also performed 120 s of isometric handgrip (IHG) at 30% maximal voluntary contraction and underwent 180 s of post-exercise ischemia (PEI) to isolate the muscle metaboreflex. The carotid BP (cBP) waveform was obtained from the right common carotid artery as the central BP waveform. We evaluated the first systolic peak (P1) and second systolic peak (P2) from the cBP waveform.

Results

SPS increased cBP with an increase in P1 (p < 0.05), whereas PEI increased cBP with an increase in P2 (p < 0.05). SPS did not alter augmentation pressure (AP) (p > 0.05), whereas PEI increased it (p < 0.05). The relative change from rest (Δ) in P1 during SPS was positively correlated with that in stroke volume (r = 0.68; p < 0.05), and the ΔAP during PEI was positively correlated with that in total peripheral resistance TPR (r = 0.61; p < 0.05).

Conclusion

These results suggest different effects of mechano- and metaboreflex on the change in shape of the central BP waveform; mechanoreflex and metaboreflex deform P1 and P2, respectively.

Editors' highlight picks from 2023 in ESC heart failure

Heart failure is a devastating syndrome affecting an increasingly high number of patients worldwide. Its aetiology and pathogenesis are complex with the involvement of factors ranging from the genetic material through valvular dysfunctions to numerous organs beyond the entire cardiovascular system. Based on continuous efforts of the heart failure scientific community we have witnessed major advances in many related disciplines during the last year. For example, epidemiological aspects-paving the road for improved risk prevention-have been thoroughly analysed for various geographical regions. Additionally, evidence-based approaches now allow the introduction of novel guideline recommended medical therapies (i.e. sodium-glucose transporter 2 inhibitors, and iron supplementation) while basic and translational research aim to explore additional molecular targets for future heart failure diagnostics and medications. All above aspects are addressed in this article, where a selection of articles published in the ESC Heart Failure journal in 2023 are highlighted. The editors are confident that the scientific contributions of ESC Heart Failure effectively served a highly relevant area of cardiovascular research last year.