Skeletal muscle metabolic recovery following submaximal exercise in chronic heart failure is limited more by O2 delivery than O2 utilization

2010 ◽  
Vol 118 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Hareld M.C. Kemps ◽  
Jeanine J. Prompers ◽  
Bart Wessels ◽  
Wouter R. De Vries ◽  
Maria L. Zonderland ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Chronic Heart Failure ◽  
Submaximal Exercise ◽  
Daily Activities ◽  
Control Group ◽  
Resonance Spectroscopy ◽  
Post Exercise ◽  
Metabolic Recovery ◽  
O2 Delivery

CHF (chronic heart failure) is associated with a prolonged recovery of skeletal muscle energy stores following submaximal exercise, limiting the ability to perform repetitive daily activities. However, the pathophysiological background of this impairment is not well established. The aim of the present study was to investigate whether muscle metabolic recovery following submaximal exercise in patients with CHF is limited by O2 delivery or O2 utilization. A total of 13 stable CHF patients (New York Heart Association classes II–III) and eight healthy subjects, matched for age and BMI (body mass index), were included. All subjects performed repetitive submaximal dynamic single leg extensions in the supine position. Post-exercise PCr (phosphocreatine) resynthesis was assessed by 31P-MRS (magnetic resonance spectroscopy). NIRS (near-IR spectroscopy) was applied simultaneously, using the rate of decrease in HHb (deoxygenated haemoglobin) as an index of post-exercise muscle re-oxygenation. As expected, PCr recovery was slower in CHF patients than in control subjects (time constant, 47±10 compared with 35±12 s respectively; P=0.04). HHb recovery kinetics were also prolonged in CHF patients (mean response time, 74±41 compared with 44±17 s respectively; P=0.04). In the patient group, HHb recovery kinetics were slower than PCr recovery kinetics (P=0.02), whereas no difference existed in the control group (P=0.32). In conclusion, prolonged metabolic recovery in CHF patients is associated with an even slower muscle tissue re-oxygenation, indicating a lower O2 delivery relative to metabolic demands. Therefore we postulate that the impaired ability to perform repetitive daily activities in these patients depends more on a reduced muscle blood flow than on limitations in O2 utilization.

Exercise training leads to a reduction of elevated myostatin levels in patients with chronic heart failure

2011 ◽  
Vol 19 (3) ◽  
pp. 404-411 ◽  
Author(s):  
Karsten Lenk ◽  
Sandra Erbs ◽  
Robert Höllriegel ◽  
Ephraim Beck ◽  
Axel Linke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Serum Concentration ◽  
Late Stage ◽  
Healthy Subjects ◽  
Fold Increase ◽  
Control Group ◽  
Cardiac Cachexia

Background: In chronic heart failure (CHF), cardiac cachexia is often associated with the terminal stage of this disease. In animal studies it has been demonstrated that myostatin, a key regulator of skeletal muscle mass, is elevated in advanced stages of this syndrome. Design: The aim of the present study was to investigate the expression of myostatin in patients with late stage CHF (NYHA IIIb) in comparison to healthy subjects. Furthermore the effects of physical exercise on myostatin were analyzed. Methods: Twenty-four patients were either randomized to a sedentary control group (CHF-S) or exercise training (CHF-E). At baseline and after 12 weeks mRNA and myostatin protein in the peripheral skeletal muscle as well as myostatin serum concentration were measured. Furthermore 12 age-matched healthy men were compared to all patients at baseline (HC). Results: CHF patients showed a two-fold increase of myostatin mRNA ( p = 0.05) and a 1.7-fold ( p = 0.01) augmentation of protein content in skeletal muscle compared to healthy subjects. In late-stage CHF, exercise training led to a 36% reduction of the mRNA and a 23% decrease of the myostatin protein compared to baseline. The serum concentration of myostatin revealed no significant alteration between the groups. Conclusion: In the skeletal muscle, myostatin increases significantly in the course of CHF. The observed effects of a significant reduction of myostatin in skeletal muscle after 12 weeks of exercise training demonstrate the reversibility of molecular changes that might be able to halt the devastating process of muscle wasting in chronic heart failure.

scholarly journals Skeletal muscle function at low work level as a model for daily activities in patients with chronic heart failure

1997 ◽  
Vol 18 (10) ◽  
pp. 1626-1631 ◽  
Author(s):  
C. Opasich ◽  
E. Pasini ◽  
R. Aquilani ◽  
F. Coelli ◽  
R. Solfrini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Chronic Heart Failure ◽  
Muscle Function ◽  
Daily Activities ◽  
Skeletal Muscle Function ◽  
Work Level

Skeletal muscle metabolism and oxygenation during post-exercise recovery in patients with chronic heart failure

1998 ◽  
Vol 4 (3) ◽  
pp. 115
Author(s):  
Akiko Hanada ◽  
Koichi Okita ◽  
Kazuya Yonezawa ◽  
Tetsuro Kohya ◽  
Takeshi Murakami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Chronic Heart Failure ◽  
Muscle Metabolism ◽  
Exercise Recovery ◽  
Post Exercise ◽  
Skeletal Muscle Metabolism ◽  
Post Exercise Recovery

Exercise training in chronic heart failure: correlation between reduced local inflammation and improved oxidative capacity in the skeletal muscle

2005 ◽  
Vol 12 (4) ◽  
pp. 393-400 ◽  
Author(s):  
Stephan Gielen ◽  
Volker Adams ◽  
Axel Linke ◽  
Sandra Erbs ◽  
Sven Möbius-Winkler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Skeletal Muscle ◽  
Chronic Heart Failure ◽  
Cytochrome C ◽  
Exercise Training ◽  
Protein Content ◽  
Cytochrome C Oxidase ◽  
Inos Expression ◽  
Control Group ◽  
Inos Protein

Background Chronic heart failure (CHF) is accompanied by an inflammatory activation which occurs both systemically and in the skeletal muscle. Exercise training has been shown to reduce the local expression of cytokines and inducible nitric oxide synthase (iNOS) in muscle biopsies of CHF patients. INOS-derived NO can inhibit oxidative phosphorylation and contribute to skeletal muscle dysfunction in CHF. Design To investigate the correlation between changes in local iNOS expression associated with regular exercise and changes in aerobic enzyme activities in the skeletal muscle of patients with CHF. Twenty male CHF patients [ejection fraction 25% (SE 2), age 54 (SE 2) years] were randomized to a training ( n = 10) or a control group (C, n = 10). Methods At baseline and after 6 months skeletal muscle iNOS expression was measured by real-time polymerase chain reaction. INOS protein and protein nitrosylation were assessed by immunohistochemistry. Cytochrome c oxidase (COX) activity was quantified electrochemically using the Clark oxygen electrode. Results Exercise training led to a 27% increase in cytochrome c oxidase activity [from 21.8 (SE 3.2) to 27.7 (SE 3.5) nmol O2/mg per min, P=0.02 versus baseline]. Changes in iNOS expression and iNOS protein content were inversely correlated with changes in COX-activity ( r= −0.60, P=0.01; r= −0.71, P<0.001). Conclusions The inverse correlation between iNOS expression/iNOS protein content and COX-activity indicates that local anti-inflammatory effects may contribute to improved muscular oxidative metabolism.

scholarly journals Atrial edema in patients with atrial fibrillation with chronic heart failure

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
VV Kirillova ◽  
OV Mochula ◽  
AA Garganeeva ◽  
VYU Usov ◽  
RE Batalov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Skeletal Muscle ◽  
Chronic Heart Failure ◽  
Interventricular Septum ◽  
Myocardial Edema ◽  
Interatrial Septum ◽  
Atrial Septum ◽  
Control Group ◽  
Constant Form

Abstract Funding Acknowledgements Type of funding sources: None. Objective to investigate the intensity of the atrial septum by T2-weighted magnetic resonance imaging (MRI) in patients with chronic heart failure (CHF), with and without atrial fibrillation (AF). Materials and methods. In patients with CHF with atrial fibrillation (n = 23, including 11 patients with paroxysmal form, and 12 patients with constant forms) and without (n = 9) of arrhythmias in the control group – almost healthy (n = 6) we evaluated the signal intensity (SI) of the interatrial septum, the interventricular septum, and skeletal muscle at MRI T-2 weighted images. An increase in the value of SI in 2 times or more compared with the SI of skeletal muscle was regarded as an MRI signs of myocardial edema. Results. The SI of the atrial septum in patients with CHF who have constant forms of atrial fibrillation is higher than in the control (2775.58 ± 383.61 relative to the control - 1448.57 ± 291.30, p &lt; 0.05). The MPP gain index in patients with paroxysmal AF equal to 1.59 ± 0.10 did not differ in comparison with patients with CHF who do not have rhythm disorders - 1.53 ± 0.12. An index of atrial septal enhancement greater than 2, indicating the presence of MRI signs of atrial septal myocardial edema  was detected only in patients with a constant form of AF (2.39 ± 0.18) than in patients with CHF with paroxysmal AF, in patients with CHF without rhythm disturbances and in the control group (1.59 ± 0.23; 1.53 ± 0.28 and 1.15 ± 0.16, respectively,  p &lt; 0.05). Summary. In patients with CHF who have a constant form of atrial fibrillation, according to T2-weighted MRI images, signs of edema of the myocardium of the atrial septum were revealed in comparison with the control group and patients with CHF who have a paroxysmal form of atrial fibrillation and without rhythm disturbances.

scholarly journals Efficacy of cardiac rehabilitation with motion assistance from wearable cyborg hybrid assistive limb in patients with chronic heart failure: a randomized controlled trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Watanabe ◽  
A Koike ◽  
H Kato ◽  
L Wu ◽  
K Hayashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Rehabilitation ◽  
Exercise Therapy ◽  
Knee Extensor ◽  
Control Group ◽  
Cardiac Events ◽  
Rehabilitation Programs ◽  
Sit To Stand ◽  
Knee Extensor Strength

Abstract Background Recent Cochrane Systematic Review suggested that the participation in cardiac rehabilitation is associated with approximately 20% lower cardiovascular mortality and morbidity. Exercise therapy is the key component of cardiac rehabilitation programs. In recent years, innovative technologies have been introduced into the field of rehabilitation, and a typical example is the wearable cyborg Hybrid Assistive Limb (HAL). The wearable cyborg HAL provides motion assistance based on detection of bioelectrical signals on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in performing usual cardiac rehabilitation programs, such as bicycle pedaling or walking. Purpose We aim to compare the efficacy of exercise therapy performed with motion assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure. Methods This clinical trial is a randomized, non-blinded, and controlled study. Twenty-eight heart failure patients (73.1±13.8 years) who have difficulty in walking at the usual walking speed of healthy subjects were randomly assigned to 2 groups (HAL group or control group) with a 1:1 allocation ratio and performed sit-to stand exercise either with HAL or without HAL for 5 to 30 minutes once a day, and 6 to 10 days during the study period. The brain natriuretic peptide (BNP), isometric knee extensor strength, standing ability (30-seconds chair-stand test: CS-30), short physical performance battery (SPPB) and 6-minute walking distance (6MWD) were measured before and after the completion of cardiac rehabilitation. Cardiac events such as death, re-hospitalization, myocardial infarction and worsening of angina pectoris and heart failure during 1 year after discharge were evaluated. Results There was no significant difference in the number of days of exercise therapy between the two groups. BNP, SPPB and 6MWD were improved in both groups. In the HAL group, the isometric knee extensor strength (0.29±0.11 vs 0.35±0.11 kgf/kg, p=0.003) significantly improved and CS-30 (5.5±5.1 vs 8.2±5.3, p=0.054) tended to improve. However, in the control group, either the isometric knee extensor strength (0.35±0.11 vs 0.36±0.14 kgf/kg, p=0.424) or CS-30 (6.0±4.3 vs 9.2±6.2, p=0.075) did not significantly change. HAL group showed significantly more improvement in the isometric knee extensor strength than control group (p=0.045). Cardiac events occurred in 20% in the HAL group and 43% in the control group. Conclusion The improvement in isometric knee extensor strength with the assistance from lumbar-type HAL suggests that exercise therapy using this device may be useful in chronic heart failure patients with flail or sarcopenia, a strong poor prognostic factor in these patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported in part by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI grant number JP17K09485) and funded by the ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (grant number 2017-PM05-03-01).

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