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• W4254561725 abstract "POINT-COUNTERPOINTREBUTTAL FROM DRS. MIDDLEKAUFF AND SINOWAYPublished Online:01 Jan 2007https://doi.org/10.1152/japplphysiol.00994b.2006MoreSectionsPDF (39 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat In the portion of the debate, Piepoli and Coats did an outstanding job reviewing the large body of work compiled by their group over the last decade or so. This body of work suggests that reflexes emanating from skeletal muscle play an important role in evoking increases in ventilation as well as sympathoconstrictor signals during exercise in congestive heart failure (HF). The authors' work suggests that peripheral limitations play an important role in determining exercise limitation seen in HF. However, it would have been informative for the readers of the Journal of Applied Physiology if the authors had dealt directly with the issue at hand, namely “whether heightened mechanoreceptor or metaboreceptor responses explain the exaggerated reflex responses seen with exercise in HF.” In limiting their review to a discussion of their impressive body of work they presented no discussion as to why the controversy exists and why Piepoli and Coats and Middlekauff and Sinoway should be afforded the opportunity to debate this issue in the first place. For our part (Middlekauff and Sinoway), we think that the debate is real and is important. We should note that we as well as the protagonists in this debate believe that peripheral issues are crucial determinants of symptomatology during exercise in HF.Speaking for our side, we were turned on to the issue of the role in the “periphery” in HF by the classic work of Zelis et al. (2) and later by LeJemtel and colleagues (1). The work cited in our review as well as that by Piepoli and Coats differed from that of Zelis et al. and LeJemtel et al. in that we assign a greater importance to the sympathetic constrictor influences seen than to the impaired vasodilatory capacity described by Zelis et al. and LeJemtel et al. Where we and our protagonists in this debate differ is that we believe that the heightened reflex responses seen in HF are due to the stimulation of afferents that are mechanically sensitive and not metabosensitive. In fact, the work we describe in our original review suggests that metabo responses are in fact attenuated. We describe a series of experiments over a 15-yr period from a number of different laboratories that are consistent with this hypothesis. These studies span the continuum of hypothesis-driven clinical investigation to studies using a decerebrate rat model of HF. We believe the experiments presented and the line of debate presented by us is systematic and compelling. We congratulate our adversaries on their important contributions to this body or work and only wish they had presented a compelling series of hypotheses on which we could further the discussion and enhance the rate at which we learn about this important reflex system.REFERENCES1 LeJemtel TH, Maskin CS, Lucido D, Chadwick BJ. Failure to augment maximal limb blood flow in response to one-leg versus two-leg exercise in patients with severe heart failure. Circulation 74: 245–251, 1986.Crossref | PubMed | ISI | Google Scholar2 Zelis R. The contribution of local factors to the elevated venous tone of congestive heart failure. J Clin Invest 54: 219–224, 1974.Crossref | ISI | Google Scholar Download PDF Previous Back to Top Next FiguresReferencesRelatedInformationCited ByRenal vasoconstriction is augmented during exercise in patients with peripheral arterial disease7 November 2013 | Physiological Reports, Vol. 1, No. 6 More from this issue > Volume 102Issue 1January 2007Pages 496-496 Copyright & PermissionsCopyright © 2007 the American Physiological Societyhttps://doi.org/10.1152/japplphysiol.00994b.2006History Published online 1 January 2007 Published in print 1 January 2007 Metrics" @default.
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• W4254561725 title "REBUTTAL FROM DRS. MIDDLEKAUFF AND SINOWAY" @default.
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