Mechanisms of sympathetic excitation during cycling exercise in heart failure with reduced ejection fraction
Bibliographic record
Abstract
Abstract Leg muscle sympathetic nerve activity (MSNA) diminishes in healthy (HC) individuals during mild dynamic exercise but not in age‐matched patients with heart failure due to reduced ejection fraction (HFrEF). To elucidate the neural mechanisms responsible for such sympathetic excitation, we studied 20 stable HFrEF patients (6F; mean age 62 ± 8 SD years) and 15 age‐matched HC (6F; mean age 59 ± 7). We quantified peak oxygen uptake () and separately, fibular MSNA (microneurography) at rest and during one‐leg cycling (2 min each, mild (unloaded) and moderate intensity (loaded = 30–40% )) throughout three interventions: (1) post‐exercise circulatory occlusion (PECO), which isolates the leg muscle metaboreflex (MMR); (2) supine posture, which stimulates cardiopulmonary baroreceptors (CPB); and (3) 32% inspired oxygen, to supress the peripheral chemoreflex (PC). One‐leg cycling increased MSNA and activated the leg MMR in patients with HFrEF but not HC. MSNA at rest and during mild exercise was lower when supine than seated in both cohorts. Breathing 32% oxygen lowered the MSNA of HC but not HFrEF. In both groups, hyperoxia decreased burst frequency during low‐intensity cycling. Hyperoxia abolished the ‘paradoxical’ sympatho‐excitation of HFrEF. Thirteen participants with HFrEF were reassessed after 4 months of conventional cardiopulmonary rehabilitation. Exercise training improved by 17% and attenuated the leg MMR response without altering CPB activation or PC suppression. We conclude that in HFrEF, all three autonomic reflexes are engaged to a varying degree by one‐leg cycling. Patient training attenuates the leg MMR without affecting CPB or PC modulation of MSNA during exercise. image Key points In HFrEF patients, an exaggerated leg MMR is the dominant sympatho‐excitatory reflex during one‐leg cycling at moderate work rates; with their MSNA response relating inversely to . Activation of the cardiopulmonary baroreflex and peripheral chemoreflex by exercise also contribute, suggesting that exercising supine or while breathing 32% O 2 may complement conventional training protocols. An exercise‐based cardiac rehabilitation programme lowers sympathetic discharge at rest and during mild intensity cycling by abolishing specifically the leg MMR response.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".