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(Circulation. 1998;98:1886-1891.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Skeletal Muscle Metabolism Limits Exercise Capacity in Patients With Chronic Heart Failure

Koichi Okita, MD; Kazuya Yonezawa, MD; Hirotaka Nishijima, MD; Akiko Hanada, MD; Mitsunori Ohtsubo, MD; Tetsuro Kohya, MD; Takeshi Murakami, MD; ; Akira Kitabatake, MD

From the Department of Cardiovascular Medicine, Hokkaido University School of Medicine, and the Sapporo Health Promotion Center, Sapporo, Japan.

Correspondence to Koichi Okita, MD, Department of Cardiovascular Medicine, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638 Japan. E-mail cvext{at}med.hokudai.ac.jp

Background—Several studies have indicated that skeletal muscle is important in determining the exercise capacity of patients with chronic heart failure (CHF). However, this theory has been investigated only in experiments based on local exercise involving a small muscle mass. We investigated skeletal muscle metabolism during maximal systemic exercise to determine whether muscle metabolism limits exercise capacity in patients with CHF. We also studied the relationship between muscle metabolic abnormalities during local and systemic exercise.

Methods and Results—Skeletal muscle metabolism was measured during maximal systemic exercise on a bicycle ergometer by a combination of the metabolic freeze method and ³¹P magnetic resonance spectroscopy in 12 patients with CHF and 7 age- and size-matched normal subjects. We also evaluated skeletal muscle metabolism during local exercise while subjects performed unilateral plantar flexion. Muscle phosphocreatine (PCr) was nearly depleted during maximal systemic exercise in patients with CHF and normal subjects (12.5±0.04% and 12.3±0.07%, respectively, of initial level). PCr depletion occurred at a significantly lower peak oxygen uptake (peak O₂) in patients with CHF than in normal subjects (CHF, 20.2±3.0 versus normal, 31.8±3.7 mL · min^-1 · kg^-1, P<0.0001). Muscle metabolic capacity, evaluated as the slope of PCr decrease in relation to increasing workload, was correlated with peak O₂ during maximal systemic exercise in patients with CHF (r=0.83, P<0.001). Muscle metabolic capacity during local exercise was impaired in patients with CHF and was correlated with capacity during systemic exercise (r=0.76, P<0.01) and with peak O₂ (r=0.83, P<0.001).

Conclusions—These results suggest that impaired muscle metabolism associated with early metabolic limitation determines exercise capacity during maximal systemic exercise in patients with CHF. There was a significant correlation between muscle metabolic capacity during systemic and local exercise in patients with CHF.

Key Words: : heart failure • exercise • muscles

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