Circulation, Vol 85, 1364-1373, Copyright © 1992 by American Heart Association
DM Mancini, G Walter, N Reichek, R Lenkinski, KK McCully, JL Mullen and JR Wilson
BACKGROUND. The purpose of this study was to investigate the prevalence of
skeletal muscle atrophy and its relation to exercise intolerance and
abnormal muscle metabolism in patients with heart failure (HF). METHODS AND
RESULTS. Peak VO2, percent ideal body weight (% IBW), 24-hour urine
creatinine (Cr), and anthropometrics were measured in 62 ambulatory
patients with HF. 31P magnetic resonance spectroscopy (MRS) and imaging
(MRI) of the calf were performed in 15 patients with HF and 10 control
subjects. Inorganic phosphorus (Pi), phosphocreatine (PCr), and
intracellular pH were measured at rest and during exercise. Calf muscle
volume was determined from the sum of the integrated area of muscle in
1-cm-thick contiguous axial images from the patella to the calcaneus. A
reduced skeletal muscle mass was noted in 68% of patients, as evidenced by
a decrease in Cr-to-height ratio of less than 7.4 mg/cm and/or upper arm
circumference of less than 5% of normal. Calf muscle volume (MRI) was also
reduced in the patients with HF (controls, 675 +/- 84 cm3/m2; HF, 567 +/-
112 cm3/m2; p less than 0.05). Fat stores were largely preserved with
triceps skinfold of less than 5% of normal and/or IBW of less than 80% in
only 8% of patients. Modest linear correlations were observed between peak
VO2 and both calf muscle volume per meter squared (r = 0.48) and midarm
muscle area (r = 0.36) (both p less than 0.05). 31P metabolic abnormalities
during exercise were observed in the patients with HF, which is consistent
with intrinsic oxidative abnormalities. The metabolic changes were weakly
correlated with muscle volume (r = -0.42, p less than 0.05). CONCLUSIONS.
These findings indicate that patients with chronic HF frequently develop
significant skeletal muscle atrophy and metabolic abnormalities. Atrophy
contributes modestly to both the reduced exercise capacity and altered
muscle metabolism.
ARTICLES
Contribution of skeletal muscle atrophy to exercise intolerance and altered muscle metabolism in heart failure
Department of Medicine, University of Pennsylvania, Philadelphia.
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