The Ergoreflex: how the Skeletal Muscle Modulates Ventilation and Cardiovascular Function in Health and Disease

Author: Alberto Aimo1,2, Luigi Francesco Saccaro1, Chiara Borrelli3, Iacopo Fabiani1,2, Francesco Gentile4, Claudio Passino1,2, Michele Emdin1,2, Massimo Francesco Piepoli5, Andrew Js Coats6,7, Alberto Giannoni1,2
1 Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
2 Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
3 Emergency Medicine Division, University Hospital of Pisa, Italy.
4 Cardiology Division, University Hospital of Pisa, Italy.
5 Cardiac Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy.
6 Monash University, Australia.
7 University of Warwick, UK.
Conference/Journal: Eur J Heart Fail
Date published: 2021 Jul 16
Other: Special Notes: doi: 10.1002/ejhf.2298. , Word Count: 185

The control of ventilation and cardiovascular function during physical activity is partially regulated by the ergoreflex, a cardiorespiratory reflex activated by physical activity. Two components of the ergoreflex have been identified: the mechanoreflex, which is activated early by muscle contraction and tendon stretch, and the metaboreflex, which responds to the accumulation of metabolites in the exercising muscles. Patients with heart failure (HF) often develop a skeletal myopathy with varying degrees of severity, from a subclinical disease to cardiac cachexia. HF-related myopathy has been associated with increased ergoreflex sensitivity, which is believed to contribute to dyspnoea on effort,fatigue and sympatho-vagal imbalance, which are hallmarks of HF. Ergoreflex sensitivity increases significantly also in patients with neuromuscular disorders. Exercise training is a valuable therapeutic option for both HF and neuromuscular disorders to blunt ergoreflex sensitivity, restore the sympatho-vagal balance, and increase the tolerance to physical exercise. A deeper knowledge of mechanisms mediating ergoreflex sensitivity might enable a drug or device modulation of this reflex when patients cannot exercise because of advanced skeletal myopathy.

Keywords: ergoreflex; exercise training; heart failure; mechanoreflex; metaboreflex; myopathy; neuromuscular disease.

PMID: 34268843 DOI: 10.1002/ejhf.2298