Skeletal Muscle Function and Its Relation to Exercise Tolerance in Chronic Heart Failure

Harrington, Derek; Anker, Stefan D.; Chua, Tuan Peng; Webb-Peploe, Katharine; Ponikowski, Piotr; Poole‐Wilson, Philip A.; Coats, Andrew J.S.

doi:10.1016/s0735-1097(97)00381-1

Cited by 351 publications

(269 citation statements)

References 35 publications

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“…Our finding contrasts with previous studies that found selected peripheral components rather than central hemodynamic parameters to be better predictors of V O 2 peak in HF (5,8,9,13,23). For example, Cicoira et al (5) demonstrated that skeletal muscle is an important determinant of exercise capacity independent of central hemodynamics in noncachectic patients with HF.…”

Section: Discussioncontrasting

confidence: 99%

“…For example, Cicoira et al (5) demonstrated that skeletal muscle is an important determinant of exercise capacity independent of central hemodynamics in noncachectic patients with HF. Leg muscle cross-sectional area has also been shown to be significantly correlated with and serve as an independent predictor of V O 2 peak in male patients with HF (13). Furthermore, exercise capacity is limited in part by the fixed delivery of blood to the periphery, especially in subjects with small muscle mass where local metabolic factors dominate (23).…”

Section: Discussionmentioning

confidence: 99%

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Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Meyer¹,

Karamanoglu²,

Kovács

2004

Journal of Applied Physiology

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. Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction. J Appl Physiol 97: 1667-1672. First published June 18, 2004 doi:10.1152/japplphysiol.00078.2004.-Impaired exercise tolerance, determined by peak oxygen consumption (V O2 peak), is predictive of mortality and the necessity for cardiac transplantation in patients with chronic heart failure (HF). However, the role of left ventricular (LV) diastolic function at rest, reflected by chamber stiffness assessed echocardiographically, as a determinant of exercise tolerance is unknown. Increased LV chamber stiffness and limitation of V O2 peak are known correlates of HF. Yet, the relationship between chamber stiffness and V O2 peak in subjects with HF has not been fully determined. Forty-one patients with HF New York Heart Association [(NYHA) class 2.4 Ϯ 0.8, mean Ϯ SD] had echocardiographic studies and V O2 peak measurements. Transmitral Doppler E waves were analyzed using a previously validated method to determine k, the LV chamber stiffness parameter. Multiple linear regression analysis of V O2 peak variance indicated that LV chamber stiffness k (r 2 ϭ 0.55) and NYHA classification (r 2 ϭ 0.43) were its best independent predictors and when taken together account for 59% of the variability in V O2 peak. We conclude that diastolic function at rest, as manifested by chamber stiffness, is a major determinant of maximal exercise capacity in HF. diastole; echocardiography; oxygen consumption CHRONIC HEART FAILURE (HF) is a major health problem that carries a high mortality rate despite continued significant advances in medical therapy. With ϳ400,000 new cases of HF diagnosed each year, 4.7 million Americans suffer from this debilitating disease (1). It has been established that patients with HF have impaired exercise tolerance that is predictive of mortality and the need for cardiac transplantation (10). Characteristically, the failing heart demonstrates an inability to maintain an adequate cardiac output, first during effort and later also at rest. Cardiac decompensation ultimately leads to impaired exercise capacity, fatigue, and exertional dyspnea. Patients with HF thus may have a decreased left ventricular (LV) ejection fraction (LVEF), large end-diastolic volume, and impaired contractile reserve (33, 34). Ventricular dysfunction as quantitated by a decreased LVEF is the main manifestation of HF that ultimately results in circulatory failure. Advanced LV dysfunction is associated with a variety of neurohumoral, peripheral circulatory, skeletal muscle, and respiratory adaptations that determine the syndrome's overall clinical presentation and prognosis (33, 34). The known mechanisms that lead to HF are highly complex, involving chamber enlargement and remodeling and decreased LV contractile reserve (10). The factor common to all types of HF regardless of etiology is increased LV end-diastolic pressure (LVEDP), which compromises LV filling, diminishes stroke volume and cardiac outpu...

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Meyer¹,

Karamanoglu²,

Kovács

2004

Journal of Applied Physiology

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“…Studies have shown that CHF is associated with reduced skeletal muscle strength per unit muscle size (9,28). This contractile deficit at the whole muscle level has been observed in isolated muscle tissue in animal models (16,21) and in chemically skinned, single muscle fibers in humans (26), suggesting that the heart failure syndrome promotes contractile dysfunction at the level of the myofilaments.…”

Section: Discussionmentioning

confidence: 98%

“…Although cardiac pump dysfunction can limit exercise capacity, research conducted over the last two decades has highlighted the importance of changes in the skeletal musculature in heart failure (10,21,37). Recent studies have shown that skeletal muscle strength is reduced in heart failure and that this decrement cannot be solely accounted for by a reduction in muscle mass (9,28), suggesting a fundamental defect in skeletal muscle contractile function. Recent studies have confirmed this at the cellular level.…”

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confidence: 99%

Skeletal muscle contractile protein function is preserved in human heart failure

Okada

Toth²,

VanBuren³

2008

Journal of Applied Physiology

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“…Mounting evidence suggests that peripheral skeletal muscle abnormalities figure prominently in the exercise intolerance associated with CHF. 2 It is now well established that a variety of exercise prescriptions can improve exercise tolerance, reverse skeletal muscle histochemical abnormalities, enhance nutritive blood flow, and possibly improve the quality of life and clinical outcome in patients with CHF. 3 Selection of the right type of exercise in treatment of New York Heart Association (NYHA) IV group patients still remains an issue, however.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Short‐term Isometric Muscle Contraction and the Valsalva Maneuver on Systemic and Pulmonary Hemodynamics in Patients with Severe Heart Failure

Soucek¹,

Fráňa²,

Kára³

et al. 2009

Clinical Cardiology

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Background: Chronic heart failure is characterized by high mortality, frequent hospitalization, and reduced quality of life. Patients with severe heart failure are often in very poor physical condition, they are unable to take part in the usual exercise programs, and therefore need an individual approach. Hypothesis: To assess the systemic and pulmonary hemodynamic responses to maximum voluntary contraction of the lower extremity muscles (MVC-LEM) with persistent physiologic breathing, the Valsalva maneuver, and the combination of Valsalva with MVC-LEM. Methods: Seventeen patients with severe heart failure (ejection fraction 20%) were exposed to 3 types of load for a period of 10 seconds: 1) MVC-LEM with persistent physiologic breathing, 2) the Valsalva maneuver, and 3) a combination of MVC-LEM with the Valsalva maneuver. During each measurement, a continuous, timesynchronized record was taken of the electrocardiogram, and the pulmonary and systemic blood pressures. Results: There were slight changes in the heart rate and systemic blood pressure when comparing resting versus MVC-LEM values. There were much greater and significant changes (P < .01) in the systemic and pulmonary blood pressures when comparing resting versus the Valsalva maneuver or the combination of the MVC-LEM plus the Valsalva maneuver values. Conclusions: A short maximum voluntary contraction of the muscles of the lower extremities with persistent physiologic breathing did not have an abnormal effect on the systemic and pulmonary hemodynamics in patients with severe chronic heart failure. The Valsalva maneuver caused significantly higher hemodynamic changes in the systemic and pulmonary system with possible negative effects.

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Skeletal Muscle Function and Its Relation to Exercise Tolerance in Chronic Heart Failure

Cited by 351 publications

References 35 publications

Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Skeletal muscle contractile protein function is preserved in human heart failure

The Effect of Short‐term Isometric Muscle Contraction and the Valsalva Maneuver on Systemic and Pulmonary Hemodynamics in Patients with Severe Heart Failure

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