Evidence map›Paper›PMID 40117701›Full record

ReviewAutonomic neuroscience : basic & clinical2025

Dissecting the exercise pressor reflex in heart failure: A multi-step failure.

Danilo Iannetta, Fabio Giuseppe Laginestra, D Walter Wray, Markus Amann

Abstract readReview
In one paragraph

Review in Autonomic neuroscience : basic & clinical, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Danilo IannettaDepartment of Anesthesiology, University of Utah, Salt Lake City, UT, United States of America; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. Electronic address: danilo.iannetta@unibs.it.
Fabio Giuseppe LaginestraDepartment of Anesthesiology, University of Utah, Salt Lake City, UT, United States of America.
D Walter WrayDepartment of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America; Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, UT, United States of America.
Markus AmannDepartment of Anesthesiology, University of Utah, Salt Lake City, UT, United States of America; Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America; Geriatric Research, Education, and Clinical Center, VA Medical Center, Salt Lake City, UT, United States of America.

Funding

Role of Sensory Neurons in Human Cardiovascular DiseaseR01HL116579 · NHLBI · UNIVERSITY OF UTAH · PI AMANN, MARKUS · 2013 to 2021
$3.4M
Autonomic Dysfunction in Patients with HFpEFR01HL162856 · NHLBI · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI MARKUS AMANN, D. Walter Wray · 2023 to 2026
$2.7M
Cardiovascular and neuromuscular issues in chronic painR01HL170007 · NHLBI · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · PI MARKUS AMANN, D. Walter Wray · 2024 to 2026
$2.3M
NHLBI NIH HHS R01 HL116579NHLBI NIH HHS R01 HL162856NHLBI NIH HHS R01 HL170007RRD VA I01 RX003343
6 · The paper itself

Abstract

The contribution of neural feedback originating from exercising limb muscles to the cardiovascular response to exercise was first recognized nearly 100 years ago. Today, it is well established that this influence is initiated by the activation of group III and IV sensory neurons with terminal endings located within contracting skeletal muscle. During exercise, these sensory neurons project feedback related to intramuscular mechanical and metabolic perturbations to medullary neural circuits which reflexively evoke decreases in parasympathetic and increases in sympathetic nervous system activity with the purpose of optimizing central and peripheral hemodynamics. Considerable evidence from animal and human studies suggests that the function of this regulatory control system, known as the exercise pressor reflex (EPR), is abnormal in heart failure and exaggerates sympatho-excitation which impairs the hemodynamic response to exercise and contributes to the functional limitations characterizing these patients. This review briefly introduces the key determinants of EPR control in health and covers the impact of heart failure on the integrity of each of its components and overall function. These include the sensitivity of group III/IV muscle afferents, afferent signal transmission in the spinal cord, and the central integration and processing of sensory feedback within the brainstem. Importantly, although most data relevant for this review come from studies in HFrEF, the limited HFpEF-specific insights are included when available. While arguably not part of the EPR, we also discuss the impact of heart failure on the exercise-induced increase of intramuscular stimuli of group III/IV muscle afferents and end-organ responsiveness to sympathetic/neurochemical stimulation.

Indexed as

ExerciseHeart FailureMuscle, SkeletalReflexAnimalsHumansAutonomic nervous systemBlood flowGroup III/IV muscle afferentsSympathetic activity

Identifiers

PMID40117701
PMCPMC12790130

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.