Influence of intrinsic limb vasodilator capacity on exercise tolerance in patients with recent myocardial infarction

To investigate the influence of intrinsic limb vasodilator capacity on exercise performance, limb reactive hyperemic flows and their relations to exercise capacity during upright bicycle exercise were examined in 52 patients with recent myocardial infarction. Reactive hyperemic flow was measured in the forearm and the calf by venous occlusive plethysmography after 5 min of arterial occlusion. Calf reactive hyperemic flow correlated significantly with cardiac output, systemic vascular resistance, and oxygen consumption at peak exercise, whereas flow in the forearm did not. In patients with preserved exercise capacity (group 1, n = 20) compared with those with exercise impairment (group 2, n = 32), calf reactive hyperemic flow was significantly augmented, but forearm flow was similar in the two groups. There were no significant differences in hemodynamic parameters at rest between the two groups. At peak exercise, however, cardiac output was lower and systemic vascular resistance was higher in group 2 than in group 1, whereas arterial blood pressure was maintained identically in the two groups. Thus, intrinsic calf but not forearm vasodilator capacity was linked to exercise hemodynamic responses and exercise capacity in patients with recent myocardial infarction. In addition, reduced calf vasodilation and concomitant enhanced vascular tone seemed to be useful for preserving arterial blood pressure in the setting of decreased cardiac output response to exercise in patients with exercise impairment.