{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:43:20Z","timestamp":1787237000231,"version":"build-2736575974"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>\n                      In heart failure, sympathetic excess and exercise intolerance impair quality of life. In heart failure with reduced ejection fraction, exercise stimulates a reflex increase in muscle sympathetic nerve activity (MSNA) that relates inversely to peak oxygen uptake (V\u0307O\n                      <jats:sub>2peak<\/jats:sub>\n                      ). Whether similar sympathoexcitatory responses are present in heart failure with preserved EF (HFpEF) and relate to V\u0307O\n                      <jats:sub>2peak<\/jats:sub>\n                      are unknown.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      In 13 patients with HFpEF (70\u00b16 years), 17 comorbidity-matched controls (CMC; 67\u00b18 years), and 18 healthy controls (65\u00b18 years), we measured heart rate, blood pressure, and MSNA (microneurography) during (1) 7-minute baseline; (2) 2-minute isometric handgrip (40% maximal voluntary contraction) or rhythmic handgrip (50% and 30% maximal voluntary contraction) exercise, followed by 2-minute postexercise circulatory occlusion; and (3) 4-minute 1-leg cycling (2 minutes each at mild and moderate intensity). V\u0307O\n                      <jats:sub>2peak<\/jats:sub>\n                      was obtained by open-circuit spirometry.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Resting MSNA was higher and V\u0307O\n                      <jats:sub>2peak<\/jats:sub>\n                      was lower in HFpEF versus CMCs and healthy controls (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05). During handgrip, MSNA increased in all groups (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05); in HFpEF, MSNA was greater than CMCs and healthy controls during HG and postexercise circulatory occlusion at 40% isometric handgrip (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05) and HG only at 50% and 30% rhythmic handgrip (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05). During cycling, MSNA (bursts\u00b7min\n                      <jats:sup>\u22121<\/jats:sup>\n                      ) decreased during mild (\u22124\u00b14;\n                      <jats:italic>P<\/jats:italic>\n                      =0.01) and moderate (\u22128\u00b16;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) cycling in healthy controls, was unchanged during mild (+1\u00b17;\n                      <jats:italic>P<\/jats:italic>\n                      =0.42) and moderate (+2\u00b18;\n                      <jats:italic>P<\/jats:italic>\n                      =0.28) cycling in CMCs, yet increased in HFpEF during mild (+8\u00b18;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) and moderate (+9\u00b110;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) cycling. In HFpEF, the change in MSNA during moderate cycling related inversely to relative (\n                      <jats:italic>r<\/jats:italic>\n                      =\u22120.72;\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.51;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01) and percent-predicted (\n                      <jats:italic>r<\/jats:italic>\n                      =\u22120.63;\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =0.39;\n                      <jats:italic>P<\/jats:italic>\n                      =0.03) V\u0307O\n                      <jats:sub>2peak<\/jats:sub>\n                      . No statistically significant relationships were detected in controls (\n                      <jats:italic>P<\/jats:italic>\n                      &gt;0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      In contrast to CMCs, patients with HFpEF exhibit augmented MSNA at rest and during exercise. The magnitude of such paradoxical sympathoexcitation during dynamic cycling relates inversely to V\u0307O\n                      <jats:sub>2peak<\/jats:sub>\n                      , consistent with a neurogenic, vasoconstrictor limit on exercise capacity in HFpEF.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.124.011962","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T05:00:28Z","timestamp":1733461228000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Sympathetic Response to 1-Leg Cycling Exercise Predicts Exercise Capacity in Patients With Heart Failure With Preserved Ejection Fraction"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7809-0729","authenticated-orcid":true,"given":"Mark B.","family":"Badrov","sequence":"first","affiliation":[{"name":"University Health Network and Sinai 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