SKELETAL-MUSCLE METABOLISM IN PATIENTS WITH CONGESTIVE-HEART-FAILURE - RELATION TO CLINICAL SEVERITY AND BLOOD-FLOW
SKELETAL-MUSCLE METABOLISM IN PATIENTS WITH CONGESTIVE-HEART-FAILURE - RELATION TO CLINICAL SEVERITY AND BLOOD-FLOW
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DOI：
10.1161/01.cir.76.5.1009
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发表时间：
1987-11-01
期刊：
影响因子：
37.8
通讯作者：
RAJAGOPALAN, B
中科院分区：
文献类型：
--
作者：
MASSIE, B;CONWAY, M;RAJAGOPALAN, B
我们和其他人之前已经证明，在充血性心力衰竭(CHF)患者的运动过程中，骨骼肌中存在过度的磷酸肌酸(PCr)耗竭和酸中毒。在本研究中，我们在22名CHF患者和11名年龄匹配的对照组中，在逐渐递增的屈指浅肌运动过程中进行了一系列的PCR和pH测量，以确定：(1)在相同的相对负荷下是否存在异常(比较至少可以部分补偿肌肉质量的差异)，(2)代谢变化的暂时性过程，(3)代谢结果与临床变量的关系，以及(4)代谢异常与前臂血流的关系。CHF患者在所有次极量运动水平下都有显著降低的[PCR值]和pH值，这些异常从低强度运动开始就很明显。CHF患者的代谢结果有相当大的异质性，22名患者中有14名的PCR值或pH值低于正常水平2个以上。在治疗方案中容量较有限的患者在低负荷时比其他充血性心力衰竭患者或对照组的[PCR]更低，尤其是pH更低。有症状的患者越多，自行车耐力越有限的患者，其pH值也越低。相比之下，患者和对照组的前臂血流量没有显著差异，前臂血流量与临床变量或代谢结果之间也没有关系。这些结果表明，许多CHF患者存在骨骼肌代谢异常，主要原因不是肌肉萎缩或血流受损。这些变化可能部分解释了具有相似程度的心功能障碍的患者的症状状态和运动能力的明显异质性。
We and others have previously demonstrated excessive phosphocreatinine (PCr) depletion and acidosis in skeletal muscle during exercising 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 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.