Circulation, Vol 78, 320-326, Copyright © 1988 by American Heart Association
BM Massie, M Conway, B Rajagopalan, R Yonge, S Frostick, J Ledingham, P Sleight and G Radda
Previous studies with 31P nuclear magnetic resonance have demonstrated that
patients with chronic congestive heart failure often exhibit increased
glycolytic metabolism and impaired oxidative phosphorylation in exercising
skeletal muscle, but the mechanism for these changes remains unresolved.
This study was conducted to determine whether these abnormalities result
from impaired blood flow or oxygen delivery. Nine patients with
mild-to-moderate congestive heart failure and nine age- and size-matched,
healthy control volunteers were studied during repetitive submaximal finger
flexion exercise under aerobic and ischemic conditions. Skeletal muscle
metabolism was assessed by 31P nuclear magnetic resonance of the flexor
digitorum superficialis muscle. During steady-state aerobic exercise at 33%
of each subject's predetermined maximum workload, the patients with
congestive heart failure exhibited significantly lower pH values (6.65 +/-
0.22 vs. 6.97 +/- 0.09, p less than 0.002) and phosphocreatine
concentrations, expressed as [phosphocreatine]/([phosphocreatine] +
[inorganic phosphate]) (0.59 +/- 0.14 vs. 0.79 +/- 0.08, p less than
0.002). Similar differences were also present throughout ischemic exercise
at the same workload. Based upon these measurements, calculated lactate
production and adenosine 5'-triphosphate consumption rates were
significantly higher in the patients with congestive heart failure. These
results indicate that in many patients with congestive heart failure
exercising muscle exhibits increased glycolytic metabolism and appears to
be metabolically less efficient in relation to external work performed.
These changes cannot be explained by impaired blood flow or oxygen delivery
alone.
ARTICLES
Skeletal muscle metabolism during exercise under ischemic conditions in congestive heart failure. Evidence for abnormalities unrelated to blood flow
Department of Biochemistry, Nuffield Department of Medicine, Oxford, United Kingdom.
This article has been cited by other articles:
 |
|
 |
|
  D. O. Okonko, A. Grzeslo, T. Witkowski, A. K.J. Mandal, R. M. Slater, M. Roughton, G. Foldes, T. Thum, J. Majda, W. Banasiak, et al. Effect of Intravenous Iron Sucrose on Exercise Tolerance in Anemic and Nonanemic Patients With Symptomatic Chronic Heart Failure and Iron Deficiency: FERRIC-HF: A Randomized, Controlled, Observer-Blinded Trial J. Am. Coll. Cardiol., January 15, 2008; 51(2): 103 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mezzani, U. Corra, C. Andriani, A. Giordano, R. Colombo, and P. Giannuzzi Anaerobic and aerobic relative contribution to total energy release during supramaximal effort in patients with left ventricular dysfunction J Appl Physiol, January 1, 2008; 104(1): 97 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Rubin Exercise Training in Heart Failure: Contradictory or Conventional? J. Am. Coll. Cardiol., June 19, 2007; 49(24): 2337 - 2340. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Momen, D. Bower, J. Boehmer, A. R. Kunselman, U. A. Leuenberger, and L. I. Sinoway Renal blood flow in heart failure patients during exercise Am J Physiol Heart Circ Physiol, December 1, 2004; 287(6): H2834 - H2839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Joyner Congestive Heart Failure: More Bad News From Exercising Muscle? Circulation, November 9, 2004; 110(19): 2978 - 2979. [Full Text] [PDF]
|
|
|
|
|
|
L. M. Smith, R. W. Barbee, K. R. Ward, and R. N. Pittman Prolonged tissue PO2 reduction after contraction in spinotrapezius muscle of spontaneously hypertensive rats Am J Physiol Heart Circ Physiol, July 1, 2004; 287(1): H401 - H407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F.-X. Blanc, O. Langeron, C. Coirault, S. Salmeron, F. Lambert, B. Riou, and Y. Lecarpentier Mechanical Properties of Tracheal Smooth Muscle Are Impaired in the Rabbit With Experimental Cardiac Pressure Overload Chest, January 1, 2004; 125(1): 236 - 242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Nusz, D. C. White, Q. Dai, A. M. Pippen, M. A. Thompson, G. B. Walton, C. J. Parsa, W. J. Koch, and B. H. Annex Vascular rarefaction in peripheral skeletal muscle after experimental heart failure Am J Physiol Heart Circ Physiol, October 1, 2003; 285(4): H1554 - H1562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. L. Pina, C. S. Apstein, G. J. Balady, R. Belardinelli, B. R. Chaitman, B. D. Duscha, B. J. Fletcher, J. L. Fleg, J. N. Myers, and M. J. Sullivan Exercise and Heart Failure: A Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention Circulation, March 4, 2003; 107(8): 1210 - 1225. [Full Text] [PDF]
|
|
|
|
|
|
A. C. Scott, R. Wensel, C. H. Davos, P. Georgiadou, M. Kemp, J. Hooper, A. J.S. Coats, and M. F. Piepoli Skeletal Muscle Reflex in Heart Failure Patients: Role of Hydrogen Circulation, January 21, 2003; 107(2): 300 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J S Coats HEART FAILURE: What causes the symptoms of heart failure? Heart, November 1, 2001; 86(5): 574 - 578. [Full Text] [PDF]
|
|
|
|
|
|
B. Mettauer, J. Zoll, H. Sanchez, E. Lampert, F. Ribera, V. Veksler, X. Bigard, P. Mateo, E. Epailly, J. Lonsdorfer, et al. Oxidative capacity of skeletal muscle in heart failure patients versus sedentary or active control subjects J. Am. Coll. Cardiol., October 1, 2001; 38(4): 947 - 954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Vescovo, M Volterrani, R Zennaro, M Sandri, C Ceconi, R Lorusso, R Ferrari, G B Ambrosio, and L Dalla Libera Apoptosis in the skeletal muscle of patients with heart failure: investigation of clinical and biochemical changes Heart, October 1, 2000; 84(4): 431 - 437. [Abstract] [Full Text]
|
|
|
|
|
|
M. S. Riley, J.a. Porszasz, M. P. K. J. Engelen, S. M. Shapiro, B. H. Brundage, and K. Wasserman Responses to constant work rate bicycle ergometry exercise in primary pulmonary hypertension: the effect of inhaled nitric oxide J. Am. Coll. Cardiol., August 1, 2000; 36(2): 547 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Hanada, K Okita, K Yonezawa, M Ohtsubo, T Kohya, T Murakami, H Nishijima, M Tamura, and A Kitabatake Dissociation between muscle metabolism and oxygen kinetics during recovery from exercise in patients with chronic heart failure Heart, February 1, 2000; 83(2): 161 - 166. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. E. O'DONNELL, C. D'ARSIGNY, S. RAJ, H. ABDOLLAH, and K. A. WEBB Ventilatory Assistance Improves Exercise Endurance in Stable Congestive Heart Failure Am. J. Respir. Crit. Care Med., December 1, 1999; 160(6): 1804 - 1811. [Abstract] [Full Text]
|
|
|
|
|
|
K. McCully, D. Mancini, and S. Levine Nuclear Magnetic Resonance Spectroscopy: Its Role in Providing Valuable Insight Into Diverse Clinical Problems Chest, November 1, 1999; 116(5): 1434 - 1441. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. dalla Libera, R. Zennaro, M. Sandri, G. B. Ambrosio, and G. Vescovo Apoptosis and atrophy in rat slow skeletal muscles in chronic heart failure Am J Physiol Cell Physiol, November 1, 1999; 277(5): C982 - C986. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Coirault, O. Langeron, F. Lambert, F.-X. Blanc, G. Lerebours, N. Claude, B. Riou, D. Chemla, and Y. Lecarpentier Impaired Skeletal Muscle Performance in the Early Stage of Cardiac Pressure Overload in Rabbits: Beneficial Effects of Angiotensin-Converting Enzyme Inhibition J. Pharmacol. Exp. Ther., October 1, 1999; 291(1): 70 - 75. [Abstract] [Full Text]
|
|
|
|
|
|
S. Nanas, J. Nanas, C. Kassiotis, G. Alexopoulos, A. Samakovli, J. Kanakakis, E. Tsolakis, and C. Roussos Respiratory Muscles Performance Is Related to Oxygen Kinetics During Maximal Exercise and Early Recovery in Patients With Congestive Heart Failure Circulation, August 3, 1999; 100(5): 503 - 508. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J Wright and L B Tan Classic techniques in medicine: The role of exercise testing in the evaluation and management of heart failure Postgrad. Med. J., August 1, 1999; 75(886): 453 - 458. [Abstract] [Full Text]
|
|
|
|
|
|
J. K. Shoemaker, H. L. Naylor, C. S. Hogeman, and L. I. Sinoway Blood Flow Dynamics in Heart Failure Circulation, June 15, 1999; 99(23): 3002 - 3008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. D. Duscha, W. E. Kraus, S. J. Keteyian, M. J. Sullivan, H. J. Green, F. H. Schachat, A. M. Pippen, C. A. Brawner, J. M. Blank, and B. H. Annex Capillary density of skeletal muscle: A contributing mechanism for exercise intolerance in class II-III chronic heart failure independent of other peripheral alterations J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1956 - 1963. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Johnson, C. Lucas, L. W. Stevenson, and M. A. Creager Effect of intensive therapy for heart failure on the vasodilator response to exercise J. Am. Coll. Cardiol., March 1, 1999; 33(3): 743 - 749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hambrecht, V. Adams, S. Gielen, A. Linke, S. Mobius-Winkler, J. Yu, J. Niebauer, H. Jiang, E. Fiehn, and G. Schuler Exercise intolerance in patients with chronic heart failure and increased expression of inducible nitric oxide synthase in the skeletal muscle J. Am. Coll. Cardiol., January 1, 1999; 33(1): 174 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Okita, K. Yonezawa, H. Nishijima, A. Hanada, M. Ohtsubo, T. Kohya, T. Murakami, and A. Kitabatake Skeletal Muscle Metabolism Limits Exercise Capacity in Patients With Chronic Heart Failure Circulation, November 3, 1998; 98(18): 1886 - 1891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Shoemaker, A. R. Kunselman, D. H. Silber, and L. I. Sinoway Maintained exercise pressor response in heart failure J Appl Physiol, November 1, 1998; 85(5): 1793 - 1799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Vescovo, L. Dalla Libera, F. Serafini, C. Leprotti, L. Facchin, M. Volterrani, C. Ceconi, and G. B. Ambrosio Improved Exercise Tolerance After Losartan and Enalapril in Heart Failure : Correlation With Changes in Skeletal Muscle Myosin Heavy Chain Composition Circulation, October 27, 1998; 98(17): 1742 - 1749. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Chin, E. N. Olson, J. A. Richardson, Q. Yang, C. Humphries, J. M. Shelton, H. Wu, W. Zhu, R. Bassel-Duby, and R. S. Williams A calcineurin-dependent transcriptional pathway controls skeletal muscle fiber type Genes & Dev., August 15, 1998; 12(16): 2499 - 2509. [Abstract] [Full Text]
|
|
|
|
 |
|
 P. Tellier, P. Lecouffe, and C Vasseur Whole-body exercise thallium imaging in smokers Vascular Medicine, February 1, 1998; 3(1): 15 - 20. [Abstract] [PDF]
|
|
|
|
|
|
B. Tikunov, S. Levine, and D. Mancini Chronic Congestive Heart Failure Elicits Adaptations of Endurance Exercise in Diaphragmatic Muscle Circulation, February 18, 1997; 95(4): 910 - 916. [Abstract] [Full Text]
|
|
|
|
|
|
R. Isnard, P. Lechat, H. Kalotka, H. Chikr, S. Fitoussi, J. Salloum, J.-L. Golmard, D. Thomas, and M. Komajda Muscular blood flow response to submaximal leg exercise in normal subjects and in patients with heart failure J Appl Physiol, December 1, 1996; 81(6): 2571 - 2579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-F. Toussaint, K. K. Kwong, F. M'Kparu, R. M. Weisskoff, P. J. Laraia, and H. L. Kantor Interrelationship of oxidative metabolism and local perfusion demonstrated by NMR in human skeletal muscle J Appl Physiol, November 1, 1996; 81(5): 2221 - 2228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Piepoli, A. L. Clark, M. Volterrani, S. Adamopoulos, P. Sleight, and A. J.S. Coats Contribution of Muscle Afferents to the Hemodynamic, Autonomic, and Ventilatory Responses to Exercise in Patients With Chronic Heart Failure : Effects of Physical Training Circulation, March 1, 1996; 93(5): 940 - 952. [Abstract] [Full Text]
|
|
|
|
 |
|
 S. Heeneman, P. J. A. Leenders, P. J. J. W. Aarts, J. F. M. Smits, J. W. Arends, and M. J. A. P. Daemen Peripheral Vascular Alterations During Experimental Heart Failure in the Rat : Do They Exist? Arterioscler. Thromb. Vasc. Biol., September 1, 1995; 15(9): 1503 - 1511. [Abstract] [Full Text]
|
|
|
|
|
|
A. Cohen-Solal, T. Laperche, D. Morvan, M. Geneves, B. Caviezel, and R. Gourgon Prolonged Kinetics of Recovery of Oxygen Consumption After Maximal Graded Exercise in Patients With Chronic Heart Failure : Analysis With Gas Exchange Measurements and NMR Spectroscopy Circulation, June 15, 1995; 91(12): 2924 - 2932. [Abstract] [Full Text]
|
|
|
|
|
|
D. M. Mancini, D. Henson, J. L. Manca, L. Donchez, and S. Levine Benefit of Selective Respiratory Muscle Training on Exercise Capacity in Patients With Chronic Congestive Heart Failure Circulation, January 15, 1995; 91(2): 320 - 329. [Abstract] [Full Text]
|
|
|
|
 |
|
 P. Tellier Whole-Body Thallium Imaging in Coronary Artery Disease Angiology, October 1, 1994; 45(10): 867 - 875. [Abstract] [PDF]
|
|