Effect of intensive therapy for heart failure on the vasodilator response to exercise

OBJECTIVES The purpose of the study was to evaluate the lower extremity vascular responsiveness to metabolic stimuli in patients with heart failure and to determine whether these responses improve acutely after intensive medical therapy. BACKGROUND Metabolic regulation of vascular tone is an important determinant of blood flow, and may be abnormal in heart failure. METHODS The leg blood flow responses were measured in 11 patients with nonedematous class III–IV heart failure before and after inpatient medical therapy and in 10 normal subjects. Venous occlusion plethysmography was used to measure peak blood flow and total hyperemi in the calf after arterial occlusion and also after isotonic ankle exercise. Measurements were repeated following short-term inpatient treatment with vasodilators and diuretics administered to decrease right atrial pressure (18 ± 2 to 7 ± 1 mm Hg), pulmonary wedge pressure (32 ± 3 to 15 ± 2 mm Hg), and systemic vascular resistance (1581 ± 200 to 938 ± 63 dynes·s·cm−5, all p < 0.02). RESULTS Leg blood flow at rest, after exercise, and during reactive hyperemi was less in heart failure patients than in control subjects. Resting leg blood flow did not increase significantly after medical therapy, but peak flow after the high level of exercise increased by 59% (p = 0.009). Total hyperemic volume in the recovery period increased by 73% (p = 0.03). Similarly, the peak leg blood flow response to ischemi increased by 88% (p = 0.04), whereas hyperemic volume rose by 98% (p = 0.1). CONCLUSIONS The calf blood flow responses to metabolic stimuli are blunted in patients with severe heart failure, and improve rapidly with intensive medical therapy.