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. 1993 Sep;70(3):247–251. doi: 10.1136/hrt.70.3.247

Increased renal and forearm vasoconstriction in response to exercise after heart transplantation.

G A Haywood 1, P J Counihan 1, J F Sneddon 1, S H Jennison 1, Y Bashir 1, W J McKenna 1
PMCID: PMC1025304  PMID: 8398495

Abstract

OBJECTIVE--To test the hypothesis that the loss of the inhibitory effect of the cardiac ventricular afferent fibres on the vasomotor centre would result in increased vasoconstrictor drive to the forearm and renal vascular beds during supine exercise in heart transplant recipients. DESIGN--Comparison of regional haemodynamic response to exercise in heart transplant recipients and two age matched control groups. SETTING--Regional heart transplant unit. PATIENTS AND METHODS--Orthotopic heart transplant recipients (n = 10), patients with NYHA class II heart failure (n = 10), and normal controls (n = 10) underwent short duration maximal supine bicycle exercise. MAIN OUTCOME MEASURES--Simultaneous measurements were made of heart rate, systemic blood pressure, oxygen consumption (VO2), forearm blood flow, and renal blood flow. Forearm blood flow was measured by forearm plethysmography and renal blood flow by continuous renal vein thermodilution. RESULTS--The peak forearm vascular resistance was significantly greater in the transplant group than in the controls (mean (SEM) 75 (18) v 40 (7) resistance units, p < 0.05). The percentage fall in renal blood flow at peak exercise was significantly greater in heart transplant recipients than in the controls (44% (4%) v 32% (4%), p < 0.05) as was the percentage increase in renal vascular resistance (transplants: 116% (19%) v controls: 78% (17%), p < 0.05). Regional haemodynamics during exercise in the heart failure group were not significantly different from those in the controls. CONCLUSIONS--These findings suggest that surgical division of the cardiac ventricular afferent fibres results in increased vasoconstrictor drive to the kidneys and non-exercising muscle during exercise. This mechanism may contribute to persistent exercise limitation and renal impairment after heart transplantation.

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Selected References

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  1. BISHOP J. M., WADE O. L., DONALD K. W. Changes in jugular and renal arteriovenous oxygen content difference during exercise in heart disease. Clin Sci. 1958 Nov;17(4):611–619. [PubMed] [Google Scholar]
  2. BUCHT H., EK J., ELIASCH H., HOLMGREN A., JOSEPHSON B., WERKO L. The effect of exercise in the recumbent position on the renal circulation and sodium excretion in normal individuals. Acta Physiol Scand. 1953;28(2-3):95–100. doi: 10.1111/j.1748-1716.1953.tb00961.x. [DOI] [PubMed] [Google Scholar]
  3. Banner N. R., Lloyd M. H., Hamilton R. D., Innes J. A., Guz A., Yacoub M. H. Cardiopulmonary response to dynamic exercise after heart and combined heart-lung transplantation. Br Heart J. 1989 Mar;61(3):215–223. doi: 10.1136/hrt.61.3.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bevegård B. S., Shepherd J. T. Reaction in man of resistance and capacity vessels in forearm and hand to leg exercise. J Appl Physiol. 1966 Jan;21(1):123–132. doi: 10.1152/jappl.1966.21.1.123. [DOI] [PubMed] [Google Scholar]
  5. Bevegård B. S., Shepherd J. T. Regulation of the circulation during exercise in man. Physiol Rev. 1967 Apr;47(2):178–213. doi: 10.1152/physrev.1967.47.2.178. [DOI] [PubMed] [Google Scholar]
  6. Counihan P. J., Frenneaux M. P., Webb D. J., McKenna W. J. Abnormal vascular responses to supine exercise in hypertrophic cardiomyopathy. Circulation. 1991 Aug;84(2):686–696. doi: 10.1161/01.cir.84.2.686. [DOI] [PubMed] [Google Scholar]
  7. DiCarlo S. E., Bishop V. S. Regional vascular resistance during exercise: role of cardiac afferents and exercise training. Am J Physiol. 1990 Mar;258(3 Pt 2):H842–H847. doi: 10.1152/ajpheart.1990.258.3.H842. [DOI] [PubMed] [Google Scholar]
  8. GREENFIELD A. D., WHITNEY R. J., MOWBRAY J. F. Methods for the investigation of peripheral blood flow. Br Med Bull. 1963 May;19:101–109. doi: 10.1093/oxfordjournals.bmb.a070026. [DOI] [PubMed] [Google Scholar]
  9. Haywood G. A., Stewart J. T., Counihan P. J., Sneddon J. F., Tighe D., Bennett E. D., McKenna W. J. Validation of bedside measurements of absolute human renal blood flow by a continuous thermodilution technique. Crit Care Med. 1992 May;20(5):659–664. doi: 10.1097/00003246-199205000-00019. [DOI] [PubMed] [Google Scholar]
  10. Higgins C. B., Vatner S. F., Franklin D., Braunwald E. Effects of experimentally produced heart failure on the peripheral vascular response to severe exercise in conscious dogs. Circ Res. 1972 Aug;31(2):186–194. doi: 10.1161/01.res.31.2.186. [DOI] [PubMed] [Google Scholar]
  11. Hirsch A. T., Levenson D. J., Cutler S. S., Dzau V. J., Creager M. A. Regional vascular responses to prolonged lower body negative pressure in normal subjects. Am J Physiol. 1989 Jul;257(1 Pt 2):H219–H225. doi: 10.1152/ajpheart.1989.257.1.H219. [DOI] [PubMed] [Google Scholar]
  12. Jones N. L. Evaluation of a microprocessor-controlled exercise testing system. J Appl Physiol Respir Environ Exerc Physiol. 1984 Nov;57(5):1312–1318. doi: 10.1152/jappl.1984.57.5.1312. [DOI] [PubMed] [Google Scholar]
  13. Mancia G., Donald D. E., Shepherd J. T. Inhibition of adrenergic outflow to peripheral blood vessels by vagal afferents from the cardiopulmonary region in the dog. Circ Res. 1973 Dec;33(6):713–721. doi: 10.1161/01.res.33.6.713. [DOI] [PubMed] [Google Scholar]
  14. Manohar M. Blood flow to the respiratory and limb muscles and to abdominal organs during maximal exertion in ponies. J Physiol. 1986 Aug;377:25–35. doi: 10.1113/jphysiol.1986.sp016174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Matsukawa K., Mitchell J. H., Wall P. T., Wilson L. B. The effect of static exercise on renal sympathetic nerve activity in conscious cats. J Physiol. 1991 Mar;434:453–467. doi: 10.1113/jphysiol.1991.sp018480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McNally P. G., Walls J., Feehally J. The effect of nifedipine on renal function in normotensive cyclosporin-A-treated renal allograft recipients. Nephrol Dial Transplant. 1990;5(11):962–968. doi: 10.1093/ndt/5.11.962. [DOI] [PubMed] [Google Scholar]
  17. Merrill A. J., Cargill W. H., Borders M. A., Cavin E. THE EFFECT OF EXERCISE ON THE RENAL PLASMA FLOW AND FILTRATION RATE OF NORMAL AND CARDIAC SUBJECTS. J Clin Invest. 1948 Mar;27(2):272–277. doi: 10.1172/JCI101943. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mohanty P. K., Thames M. D., Arrowood J. A., Sowers J. R., McNamara C., Szentpetery S. Impairment of cardiopulmonary baroreflex after cardiac transplantation in humans. Circulation. 1987 May;75(5):914–921. doi: 10.1161/01.cir.75.5.914. [DOI] [PubMed] [Google Scholar]
  19. Pflugfelder P. W., Purves P. D., McKenzie F. N., Kostuk W. J. Cardiac dynamics during supine exercise in cyclosporine-treated orthotopic heart transplant recipients: assessment by radionuclide angiography. J Am Coll Cardiol. 1987 Aug;10(2):336–341. doi: 10.1016/s0735-1097(87)80016-5. [DOI] [PubMed] [Google Scholar]
  20. Pope S. E., Stinson E. B., Daughters G. T., 2nd, Schroeder J. S., Ingels N. B., Jr, Alderman E. L. Exercise response of the denervated heart in long-term cardiac transplant recipients. Am J Cardiol. 1980 Aug;46(2):213–218. doi: 10.1016/0002-9149(80)90060-0. [DOI] [PubMed] [Google Scholar]
  21. Rowell L. B. Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev. 1974 Jan;54(1):75–159. doi: 10.1152/physrev.1974.54.1.75. [DOI] [PubMed] [Google Scholar]
  22. Stevenson L. W., Sietsema K., Tillisch J. H., Lem V., Walden J., Kobashigawa J. A., Moriguchi J. Exercise capacity for survivors of cardiac transplantation or sustained medical therapy for stable heart failure. Circulation. 1990 Jan;81(1):78–85. doi: 10.1161/01.cir.81.1.78. [DOI] [PubMed] [Google Scholar]
  23. Thames M. D., Abboud F. M. Interaction of somatic and cardiopulmonary receptors in control of renal circulation. Am J Physiol. 1979 Nov;237(5):H560–H565. doi: 10.1152/ajpheart.1979.237.5.H560. [DOI] [PubMed] [Google Scholar]
  24. Thames M. D., Miller B. D., Abboud F. M. Baroreflex regulation of renal nerve activity during volume expansion. Am J Physiol. 1982 Nov;243(5):H810–H814. doi: 10.1152/ajpheart.1982.243.5.H810. [DOI] [PubMed] [Google Scholar]
  25. WHITNEY R. J. The measurement of volume changes in human limbs. J Physiol. 1953 Jul;121(1):1–27. doi: 10.1113/jphysiol.1953.sp004926. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Walker J. L., Abboud F. M., Mark A. L., Thames M. D. Interaction of cardiopulmonary and somatic reflexes in humans. J Clin Invest. 1980 Jun;65(6):1491–1497. doi: 10.1172/JCI109814. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wilson R. F., Christensen B. V., Olivari M. T., Simon A., White C. W., Laxson D. D. Evidence for structural sympathetic reinnervation after orthotopic cardiac transplantation in humans. Circulation. 1991 Apr;83(4):1210–1220. doi: 10.1161/01.cir.83.4.1210. [DOI] [PubMed] [Google Scholar]

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