Circulation, Vol 85, 1751-1759, Copyright © 1992 by American Heart Association
H Drexler, U Riede, T Munzel, H Konig, E Funke and H Just
BACKGROUND. The present study was designed to define the prevalence and
characteristics of skeletal muscle alterations in patients with chronic
heart failure (CHF) and their relation to exercise capacity. METHODS AND
RESULTS. The ultrastructure of skeletal muscle was analyzed by
ultrastructural morphometry in 57 patients with CHF and 18 healthy
controls. The volume density of mitochondria (Vvm) and the surface density
(Svmc) of mitochondrial cristae were evaluated as a structural correlate of
oxidative capacity of skeletal muscle. Vvm and Svmc were reduced by
approximately 20% in patients with severe CHF irrespective of age and
etiology. The cytochrome oxidase activity in mitochondria as determined by
cytochemistry and subsequent morphometry in a subset of patients (n = 10)
was significantly decreased in heart failure (p less than 0.01). The
capillary length density of skeletal muscle was reduced in CHF (n = 12, p
less than 0.05), and the fiber type distribution was shifted to type II
fibers (n = 15, p less than 0.05). Vvm and Svmc were significantly related
to peak exercise VO2 (r = 0.56, p less than 0.001, n = 60) and to VO2 at
anaerobic threshold (r = 0.535, p less than 0.0001, n = 60). In 16 patients
with severe heart failure, Vvm was inversely related to the duration of
heart failure (r = 0.545, p less than 0.03). In 11 patients who underwent
repeat biopsies after 4 months, a correlation was observed between the
change in Vvm and the change in peak exercise VO2 (r = 0.89, p less than
0.001). CONCLUSIONS. These findings indicate that patients with CHF develop
significant ultrastructural abnormalities of skeletal muscle reflecting a
depressed oxidative capacity of working muscle. It appears that these
alterations of skeletal muscle contribute to the decreased exercise
capacity of these patients but are, in principle, reversible by an
effective treatment regimen.
ARTICLES
Alterations of skeletal muscle in chronic heart failure
Medizinische Klinik III, Universitat Freiburg, FRG.
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