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Circulation, Vol 84, 1597-1607, Copyright © 1991 by American Heart Association
MJ Sullivan, HJ Green and FR Cobb
BACKGROUND. Exertional fatigue, which frequently limits exercise in
patients with chronic heart failure, is associated with early anaerobic
metabolism in skeletal muscle. The present study was designed to examine
the skeletal muscle metabolic response to exercise in this disorder and
determine the relation of reduced muscle blood flow and skeletal muscle
biochemistry and histology to the early onset of anaerobic metabolism in
patients. METHODS AND RESULTS. We evaluated leg blood flow, blood lactate,
and skeletal muscle metabolic responses (by vastus lateralis biopsies)
during upright bicycle exercise in 11 patients with chronic heart failure
(ejection fraction 21 +/- 8%) and nine normal subjects. In patients
compared to normal subjects, peak exercise oxygen consumption was decreased
(13.0 +/- 3.3 ml/kg/min versus 30.2 +/- 8.6 ml/kg/min, p less than 0.01),
whereas peak respiratory exchange ratio and femoral venous oxygen content
were not different (both p greater than 0.25), indicating comparable
exercise end points. At rest in patients versus normals, there was a
reduction in the activity of hexokinase (p = 0.08), citrate synthetase (p
less than 0.02), succinate dehydrogenase (p = 0.0007), and 3-hydroxyacyl
CoA dehydrogenase (p = 0.04). In patients, leg blood flow was decreased at
rest, submaximal, and maximal exercise when compared to normal subjects
(all p less than 0.05), and blood lactate accumulation was accelerated. In
patients, during submaximal exercise blood lactate levels were not closely
related to leg blood flow but were inversely related to rest citrate
synthetase activity in skeletal muscle (r = -0.74, p less than 0.05). At
peak exercise there were no intergroup differences in skeletal muscle
glycolytic intermediates, adenosine nucleotides, or glycogen, whereas in
patients compared to normal subjects less lactate accumulation and
phosphocreatine depletion were noted (both p less than 0.05), suggesting
that factors other than the magnitude of phosphocreatine depletion or
lactate accumulation may influence skeletal muscle fatigue in this
disorder. CONCLUSIONS. The results of the present study suggest that in
patients with chronic heart failure reduced aerobic activity in skeletal
muscle plays an important role in mediating the early onset of anaerobic
metabolism during exercise. Our findings are consistent with the concept
that reduced aerobic enzyme activity in skeletal muscle is, in part,
responsible for determining exercise tolerance and possibly the response to
chronic intervention in patients with chronic heart failure.
ARTICLES
Altered skeletal muscle metabolic response to exercise in chronic heart failure. Relation to skeletal muscle aerobic enzyme activity
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
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