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Skeletal muscle blood flow in heart failure

Associate Professor Michelle Keske, Institution: Deakin University

2019 Vanguard Grant

Years funded: 2020-2021


Heart failure with preserved ejection fraction (HFpEF) reflects the inability of the cardiovascular system to provide sufficient blood flow to meet the needs of the body. The condition is accelerated in people with type 2 diabetes (T2D). People with this disease also have poorly controlled blood sugar levels and they also cannot exercise effectively which causes fatigue and breathlessness. This makes simple tasks (e.g. walking, housework, shopping) very difficult for sufferers and significantly reduces their quality of life. It has always been assumed that people with T2D and HFpEF have reduced exercise capacity due to impaired heart function.

However, capillaries (the smallest blood vessels in our body) in skeletal muscle are very important for delivering oxygen to contracting muscle which is vital for sustained exercise. Capillaries are also important for delivering sugar from food to the muscle for metabolism and storage. We have important new clinical data demonstrating that decreased blood flow through capillaries in skeletal muscle, rather than problems with the heart, is the main driver of reduced exercise capacity in T2D and HFpEF and is likely to contribute to poorer blood sugar control.

Current treatments for poor exercise capacity are largely ineffective because the focus has been on improving heart function rather than the small capillaries in skeletal muscle. This application builds on our preliminary data to investigate the efficacy of a home-based exercise intervention as a practical and novel vascular based therapy to improve blood sugar control and improve their ability to exercise. This research will radically change our understanding of this condition and will lay the foundation for future research investigating new effective capillary related therapies.

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