运动时肌肉代谢感受器反射引起的冠状动脉收缩限制心力衰竭时心室收缩性。
Muscle metaboreflex-induced coronary vasoconstriction limits ventricular contractility during dynamic exercise in heart failure.
机构信息
Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA.
出版信息
Am J Physiol Heart Circ Physiol. 2013 Apr 1;304(7):H1029-37. doi: 10.1152/ajpheart.00879.2012. Epub 2013 Jan 25.
Muscle metaboreflex activation (MMA) during dynamic exercise increases cardiac work and myocardial O2 demand via increases in heart rate, ventricular contractility, and afterload. This increase in cardiac work should lead to metabolic coronary vasodilation; however, no change in coronary vascular conductance occurs. This indicates that the MMA-induced increase in sympathetic activity to the heart, which raises heart rate, ventricular contractility, and cardiac output, also elicits coronary vasoconstriction. In heart failure, cardiac output does not increase with MMA presumably due to impaired ability to improve left ventricular contractility. In this setting actual coronary vasoconstriction is observed. We tested whether this coronary vasoconstriction could explain, in part, the reduced ability to increase cardiac performance during MMA. In conscious, chronically instrumented dogs before and after pacing-induced heart failure, MMA responses during mild exercise were observed before and after α1-adrenergic blockade (prazosin 20-50 μg/kg). During MMA, the increases in coronary vascular conductance, coronary blood flow, maximal rate of left ventricular pressure change, and cardiac output were significantly greater after α1-adrenergic blockade. We conclude that in subjects with heart failure, coronary vasoconstriction during MMA limits the ability to increase left ventricular contractility.
运动时的肌肉代谢反射激活(MMA)通过增加心率、心室收缩力和后负荷来增加心脏做功和心肌 O2 需求。这种心脏做功的增加应该导致代谢性冠脉血管舒张;然而,冠脉血管传导并没有发生变化。这表明 MMA 引起的心脏交感神经活动增加,提高了心率、心室收缩力和心输出量,也引起了冠脉血管收缩。在心力衰竭中,由于左心室收缩力改善能力受损,心输出量不会随 MMA 增加。在这种情况下,观察到实际的冠脉血管收缩。我们测试了这种冠脉血管收缩是否可以部分解释在 MMA 期间增加心脏性能的能力降低。在起搏诱导心力衰竭前后,在清醒、慢性仪器化的狗中,观察到轻度运动期间 MMA 反应,然后进行α1-肾上腺素能阻断(哌唑嗪 20-50μg/kg)。在 MMA 期间,在 α1-肾上腺素能阻断后,冠脉血管传导、冠脉血流、左心室压力变化的最大速率和心输出量的增加显著更大。我们的结论是,在心力衰竭患者中,MMA 期间的冠脉血管收缩限制了增加左心室收缩力的能力。