Circulation, Vol 76, 1009-1019, Copyright © 1987 by American Heart Association
B Massie, M Conway, R Yonge, S Frostick, J Ledingham, P Sleight, G Radda and B Rajagopalan
We and others have previously demonstrated excessive phosphocreatine (PCr)
depletion and acidosis in skeletal muscle during exercise in patients with
congestive heart failure (CHF). In the present study, we performed serial
measurements of PCr and pH during gradually incremental flexor digitorum
superficialis exercise in 22 patients with CHF and 11 age-matched controls
to determine: (1) whether abnormalities were present at the same relative
workloads (a comparison that would at least partially compensate for
differences in muscle mass), (2) the temporable course of the metabolic
changes, (3) the relationship of the metabolic findings to clinical
variables, and (4) the relationship of the metabolic abnormalities to
forearm blood flow. The patients with CHF had significantly lower [PCr] and
pH at all submaximal levels of exercise, and these abnormalities were
apparent from the onset of low- level exercise. There was considerable
heterogeneity among the patients with CHF with respect to the metabolic
findings, with 14 of 22 exhibiting either PCr or pH values more than 2 SDs
below normal. Patients whose capacity was more limited during the protocol
had lower [PCr], and especially pH, at low loads than did other patients
with CHF or the control subjects. The more symptomatic patients and those
with more limited bicycle exercise tolerance also had lower pH values. In
contrast, there were no significant differences in forearm blood flow
between the patients and controls and no relationship between forearm blood
and either clinical variables or the metabolic findings. These results
indicate that skeletal muscle metabolic abnormalities are present in many
patients with CHF and that they are not primarily due to either muscle
atrophy or impaired blood flow. These changes may explain in part the
marked heterogeneity of symptom status and exercise capacity of patients
with similar degrees of cardiac dysfunction.
ARTICLES
Skeletal muscle metabolism in patients with congestive heart failure: relation to clinical severity and blood flow
Department of Biochemistry, Nuffield Department of Medicine, Oxford, U.K.
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