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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B. D. Duscha, W. E. Kraus, S. J. Keteyian, M. J. Sullivan, H. J. Green, F. H. Schachat, A. M. Pippen, C. A. Brawner, J. M. Blank, and B. H. Annex Capillary density of skeletal muscle: A contributing mechanism for exercise intolerance in class II-III chronic heart failure independent of other peripheral alterations J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1956 - 1963. [Abstract] [Full Text] [PDF]
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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]
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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]
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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]
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G. C. M. Beaufort-Krol, W. G. Zijlstra, J. Takens, M. C. Molenkamp, K. J. Meuzelaar, G. B. Smid, and J. R. G. Kuipers Lactate kinetics at rest and during exercise in lambs with aortopulmonary shunts J Appl Physiol, March 1, 1999; 86(3): 832 - 839. [Abstract] [Full Text] [PDF]
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S. D. Anker and A. J. S. Coats Cardiac Cachexia: A Syndrome With Impaired Survival and Immune and Neuroendocrine Activation Chest, March 1, 1999; 115(3): 836 - 847. [Abstract] [Full Text] [PDF]
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A Simonini, K Chang, P Yue, C S Long, and B M Massie Expression of skeletal muscle sarcoplasmic reticulum calcium-ATPase is reduced in rats with postinfarction heart failure Heart, March 1, 1999; 81(3): 303 - 307. [Abstract] [Full Text]
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R. Hambrecht, V. Adams, S. Gielen, A. Linke, S. Mobius-Winkler, J. Yu, J. Niebauer, H. Jiang, E. Fiehn, and G. Schuler Exercise intolerance in patients with chronic heart failure and increased expression of inducible nitric oxide synthase in the skeletal muscle J. Am. Coll. Cardiol., January 1, 1999; 33(1): 174 - 179. [Abstract] [Full Text] [PDF]
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M. Hulsmann, B. Stanek, B. Frey, B. Sturm, D. Putz, T. Kos, R. Berger, W. Woloszczuk, G. Maurer, and R. Pacher Value of cardiopulmonary exercise testing and big endothelin plasma levels to predict short-term prognosis of patients with chronic heart failure J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1695 - 1700. [Abstract] [Full Text] [PDF]
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J. K. Shoemaker, A. R. Kunselman, D. H. Silber, and L. I. Sinoway Maintained exercise pressor response in heart failure J Appl Physiol, November 1, 1998; 85(5): 1793 - 1799. [Abstract] [Full Text] [PDF]
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G. Vescovo, L. Dalla Libera, F. Serafini, C. Leprotti, L. Facchin, M. Volterrani, C. Ceconi, and G. B. Ambrosio Improved Exercise Tolerance After Losartan and Enalapril in Heart Failure : Correlation With Changes in Skeletal Muscle Myosin Heavy Chain Composition Circulation, October 27, 1998; 98(17): 1742 - 1749. [Abstract] [Full Text] [PDF]
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U. N. Riede, U. Forstermann, H. Drexler, and with the technical assistance of Brigitte Freudenb Inducible nitric oxide synthase in skeletal muscle of patients with chronic heart failure J. Am. Coll. Cardiol., October 1, 1998; 32(4): 964 - 969. [Abstract] [Full Text] [PDF]
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D. P. Thomas, O. Hudlicka, M. D. Brown, and D. Deveci Alterations in small arterioles precede changes in limb skeletal muscle after myocardial infarction Am J Physiol Heart Circ Physiol, September 1, 1998; 275(3): H1032 - H1039. [Abstract] [Full Text] [PDF]
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E. Lampert, B. Mettauer, H. Hoppeler, A. Charloux, A. Charpentier, and J. Lonsdorfer Skeletal muscle response to short endurance training in heart transplant recipients J. Am. Coll. Cardiol., August 1, 1998; 32(2): 420 - 426. [Abstract] [Full Text] [PDF]
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G. Vescovo, C. Ceconi, P. Bernocchi, R. Ferrari, U. Carraro, G. B. Ambrosio, and L. Dalla Libera Skeletal muscle myosin heavy chain expression in rats with monocrotaline-induced cardiac hypertrophy and failure. Relation to blood flow and degree of muscle atrophy Cardiovasc Res, July 1, 1998; 39(1): 233 - 241. [Abstract] [Full Text] [PDF]
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R. P Wielenga, A. J S Coats, W. L Mosterd, and I. A Huisveld The role of exercise training in chronic heart failure Heart, November 1, 1997; 78(5): 431 - 436. [Full Text] [PDF]
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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]
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B. Tikunov, S. Levine, and D. Mancini Chronic Congestive Heart Failure Elicits Adaptations of Endurance Exercise in Diaphragmatic Muscle Circulation, February 18, 1997; 95(4): 910 - 916. [Abstract] [Full Text]
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C. C. Lang, D. B. Chomsky, G. Rayos, T. K. Yeoh, and J. R. Wilson Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure J Appl Physiol, January 1, 1997; 82(1): 257 - 261. [Abstract] [Full Text] [PDF]
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J. R. Wilson, J. Groves, and G. Rayos Circulatory Status and Response to Cardiac Rehabilitation in Patients With Heart Failure Circulation, October 1, 1996; 94(7): 1567 - 1572. [Abstract] [Full Text]
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A. Simonini, C. S. Long, G. A. Dudley, P. Yue, J. McElhinny, and B. M. Massie Heart Failure in Rats Causes Changes in Skeletal Muscle Morphology and Gene Expression That Are Not Explained by Reduced Activity Circ. Res., July 1, 1996; 79(1): 128 - 136. [Abstract] [Full Text]
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M. Piepoli, A. L. Clark, M. Volterrani, S. Adamopoulos, P. Sleight, and A. J.S. Coats Contribution of Muscle Afferents to the Hemodynamic, Autonomic, and Ventilatory Responses to Exercise in Patients With Chronic Heart Failure : Effects of Physical Training Circulation, March 1, 1996; 93(5): 940 - 952. [Abstract] [Full Text]
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D. M. Mancini, D. Henson, J. L. Manca, L. Donchez, and S. Levine Benefit of Selective Respiratory Muscle Training on Exercise Capacity in Patients With Chronic Congestive Heart Failure Circulation, January 15, 1995; 91(2): 320 - 329. [Abstract] [Full Text]
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J. R. Wilson Exercise Intolerance in Heart Failure : Importance of Skeletal Muscle Circulation, January 15, 1995; 91(2): 559 - 561. [Full Text]
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