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What can we learn about treating heart failure from the heart's response to acute exercise? Focus on the coronary
Ilkka Heinonen1, Oana Sorop2, Vincent J de Beer2
1Division of Experimental Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland.
Insights
Heart failure disrupts myocardial oxygen balance due to coronary microvascular dysfunction. Exercise may improve this, but its impact on endothelial function and oxidative stress, especially with risk factors, remains unclear.
Area of Science:
- Cardiovascular Physiology
- Exercise Science
Background:
- Cardiac function relies on adequate oxygen supply via the coronary microvasculature.
- Close interaction between cardiomyocytes and coronary endothelium influences cardiac function.
- Myocardial oxygen balance is compromised in heart failure due to compression and microvascular dysfunction.
Purpose of the Study:
- To review the disturbance of myocardial oxygen balance in heart failure.
- To examine exercise-induced perturbations in oxygen balance.
- To explore the potential of exercise training to restore oxygen balance, focusing on endothelial function and oxidative stress.
Main Methods:
- Literature review of studies on coronary microvascular function, cardiac function, and heart failure.
- Analysis of evidence regarding exercise effects on myocardial oxygen balance.
- Examination of the role of risk factors like diabetes, obesity, and hypercholesterolemia.
Main Results:
- Failing hearts exhibit disturbed myocardial oxygen balance, worsened by exercise.
- Exercise-induced imbalances stem from neurohumoral changes, endothelial dysfunction, and oxidative stress.
- Animal studies suggest exercise training can partially restore oxygen balance.
Conclusions:
- The extent to which exercise training improves coronary microvascular endothelial function and reduces oxidative stress in heart failure is largely unknown.
- The impact of common risk factors on these potential exercise benefits requires further investigation.
Abstract:
Coronary microvascular function and cardiac function are closely related in that proper cardiac function requires adequate oxygen delivery through the coronary microvasculature. Because of the close proximity of cardiomyocytes and coronary microvascular endothelium, cardiomyocytes not only communicate their metabolic needs to the coronary microvasculature, but endothelium-derived factors also directly modulate cardiac function. This review summarizes evidence that the myocardial oxygen balance is disturbed in the failing heart because of increased extravascular compressive forces and coronary microvascular dysfunction. The perturbations in myocardial oxygen balance are exaggerated during exercise and are due to alterations in neurohumoral influences, endothelial function, and oxidative stress. Although there is some evidence from animal studies that the myocardial oxygen balance can partly be restored by exercise training, it is largely unknown to what extent the beneficial effects of exercise training include improvements in endothelial function and/or oxidative stress in the coronary microvasculature and how these improvements are impacted by risk factors such as diabetes, obesity, and hypercholesterolemia.
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