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.
This article has been cited by other articles:
 |
|
 |
|
  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]
|
|
|
|
|
|
P. Szentesi, M. A. Bekedam, B. J. van Beek-Harmsen, W. J. van der Laarse, R. Zaremba, A. Boonstra, F. C. Visser, and G. J. M. Stienen Depression of force production and ATPase activity in different types of human skeletal muscle fibers from patients with chronic heart failure J Appl Physiol, December 1, 2005; 99(6): 2189 - 2195. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Smith, J. H. Mitchell, R. H. Naseem, and M. G. Garry Mechanoreflex Mediates the Exaggerated Exercise Pressor Reflex in Heart Failure Circulation, October 11, 2005; 112(15): 2293 - 2300. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Smith, M. A. Williams, J. H. Mitchell, P. P.A. Mammen, and M. G. Garry The Capsaicin-Sensitive Afferent Neuron in Skeletal Muscle Is Abnormal in Heart Failure Circulation, April 26, 2005; 111(16): 2056 - 2065. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. J. Meyer, D. Lossnitzer, A. V. Kristen, A. M. Schoene, W. Kubler, H. A. Katus, and M. M. Borst Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension Eur. Respir. J., January 1, 2005; 25(1): 125 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Montes de Oca, S. H. Torres, J. G. Loyo, F. Vazquez, N. Hernandez, B. Anchustegui, and J. J. Puigbo Exercise Performance and Skeletal Muscles in Patients With Advanced Chagas Disease Chest, April 1, 2004; 125(4): 1306 - 1314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Smith, P. P.A. Mammen, J. H. Mitchell, and M. G. Garry Role of the Exercise Pressor Reflex in Rats With Dilated Cardiomyopathy Circulation, September 2, 2003; 108(9): 1126 - 1132. [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]
|
|
|
|
 |
|
 E. De Sousa, P. Lechene, D. Fortin, B. N'Guessan, S. Belmadani, X. Bigard, V. Veksler, and R. Ventura-Clapier Cardiac and skeletal muscle energy metabolism in heart failure: beneficial effects of voluntary activity Cardiovasc Res, November 1, 2002; 56(2): 260 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. W. Booth, M. V. Chakravarthy, S. E. Gordon, and E. E. Spangenburg Waging war on physical inactivity: using modern molecular ammunition against an ancient enemy J Appl Physiol, July 1, 2002; 93(1): 3 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J Wright, K M Khan, E M Gossage, and S Saltissi Assessment of a low-intensity cardiac rehabilitation programme using the six-minute walk test Clinical Rehabilitation, February 1, 2001; 15(2): 119 - 124. [Abstract] [PDF]
|
|
|
|
 |
|
 P Faggiano, A D'Aloia, A Gualeni, and A Giordano Relative contribution of resting haemodynamic profile and lung function to exercise tolerance in male patients with chronic heart failure Heart, February 1, 2001; 85(2): 179 - 184. [Abstract] [Full Text]
|
|
|
|
|
|
B. D Duscha, B. H Annex, S. J Keteyian, H. J. Green, M. J. Sullivan, G. P. Samsa, C. A. Brawner, F. H. Schachat, and W. E. Kraus Differences in skeletal muscle between men and women with chronic heart failure J Appl Physiol, January 1, 2001; 90(1): 280 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Le Tourneau, P. de Groote, A. Millaire, C. Foucher, C. Savoye, P. Pigny, A. Prat, H. Warembourg, and J. M. Lablanche Effect of mitral valve surgery on exercise capacity, ventricular ejection fraction and neurohormonal activation in patients with severe mitral regurgitation J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2263 - 2269. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. L. Jones and K. J. Killian Exercise Limitation in Health and Disease N. Engl. J. Med., August 31, 2000; 343(9): 632 - 641. [Full Text] [PDF]
|
|
|
|
|
|
A. Maiorana, G. O'Driscoll, C. Cheetham, J. Collis, C. Goodman, S. Rankin, R. Taylor, and D. Green Combined aerobic and resistance exercise training improves functional capacity and strength in CHF J Appl Physiol, May 1, 2000; 88(5): 1565 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. R Gosker, E. F. Wouters, G. J van der Vusse, and A. M. Schols Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1033 - 1047. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kiilavuori, H. Naveri, T. Salmi, and M. Harkonen The effect of physical training on skeletal muscle in patients with chronic heart failure Eur J Heart Fail, March 1, 2000; 2(1): 53 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N M Picozzi, A L Clark, K A Lindsay, G P McCann, and W S Hillis Responses to constant work exercise in patients with chronic heart failure Heart, October 1, 1999; 82(4): 482 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Opasich, N. Ambrosino, G. Felicetti, R. Aquilani, E. Pasini, D. Bergitto, A. Mazza, F. Cobelli, and L. Tavazzi Heart failure-related myopathy. Clinical and pathophysiological insights Eur. Heart J., August 2, 1999; 20(16): 1191 - 1200. [Abstract] [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]
|
|
|
|
 |
|
 Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease . A Statement of the American Thoracic Society and European Respiratory Society Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): S2 - 40. [Full Text] [PDF]
|
|
|
|
|
|
R. Tyni-Lenne, E. Jansson, and C. Sylven Female-related skeletal muscle phenotype in patients with moderate chronic heart failure before and after dynamic exercise training Cardiovasc Res, April 1, 1999; 42(1): 99 - 103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Adams, H. Jiang, J. Yu, S. Mobius-Winkler, E. Fiehn, A. Linke, C. Weigl, G. Schuler, and R. Hambrecht Apoptosis in skeletal myocytes of patients with chronic heart failure is associated with exercise intolerance J. Am. Coll. Cardiol., March 15, 1999; 33(4): 959 - 965. [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]
|
|
|
|
|
|
F. Maltais, J. Jobin, M. J. Sullivan, S. Bernard, F. Whittom, K. J. Killian, M. Desmeules, M. Belanger, and P. LeBlanc Metabolic and hemodynamic responses of lower limb during exercise in patients with COPD J Appl Physiol, May 1, 1998; 84(5): 1573 - 1580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Delp, C. Duan, J. P. Mattson, and T. I. Musch Changes in skeletal muscle biochemistry and histology relative to fiber type in rats with heart failure J Appl Physiol, October 1, 1997; 83(4): 1291 - 1299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Pickar, J. P. Mattson, S. Lloyd, and T. I. Musch Decreased [3H]ouabain binding sites in skeletal muscle of rats with chronic heart failure J Appl Physiol, July 1, 1997; 83(1): 323 - 323. [Abstract] [Full Text] [PDF]
|
|