Effects of cardiac transplantation on bioenergetic abnormalities of skeletal muscle in congestive heart failure.
Effects of cardiac transplantation on bioenergetic abnormalities of skeletal muscle in congestive heart failure.
复制标题
心脏移植对充血性心力衰竭骨骼肌生物能异常的影响。
DOI：
10.1161/01.cir.89.4.1624
复制
发表时间：
1994
期刊：
影响因子：
37.8
通讯作者：
B. Rajagopalan
中科院分区：
文献类型：
--
作者：
John R. Stratton;G. J. Kemp;Richard C. Daly;Sir Magdi Yacoub;B. Rajagopalan
背景
晚期心力衰竭患者在运动过程中骨骼肌代谢存在生物能量异常。利用31 P磁共振波谱，我们试图确定是否骨骼代谢反应运动正常化原位心脏移植。
方法和结果
研究了四组：健康的正常志愿者（n = 9）、等待心脏移植的受试者（n = 10）、移植后< 6个月（平均4个月）的受试者（n = 9）和移植后> 6个月（平均15个月）的受试者（n = 8）。移植后患者在研究时均无排斥反应的活检证据。三组患者在年龄、术前功能分级或症状持续时间方面无显著差异。通过31 P磁共振波谱法监测在递增重量拉动运动和10分钟恢复期间优势臂的代谢反应，测量pH值和磷酸肌酸（PCr）/（PCr +无机磷酸盐[Pi]）比率，PCr浓度的指数。此外，根据恢复数据，计算PCr再合成率作为氧化代谢的指标，该指标与工作水平、招募或肌肉质量无关，并确定线粒体ATP合成的有效最大速率（Vmax）。通过ANOVA进行分析。两组之间的pH值或PCr/（PCr + Pi）在静息时无差异。与正常对照组相比，移植前组运动持续时间减少（11.3 +/- 2.5 vs 15.0 +/- 1.3分钟，P = 0.02），较低的次极量运动PCr/（PCr + Pi）比值（0.58 +/- 0.11对比0.76 +/- 0.08，P <0.05），PCr再合成率降低（13 +/- 6 vs 22 +/- 9 mmol/L/min，P < .05），计算的Vmax较低（26 +/- 14 vs 53 +/- 26 mmol/L/min，P < .05）。在移植后早期研究的组中，移植前组中观察到的所有变化都持续存在，如果有任何变化的话，情况会更糟。在移植后晚期研究组中，与移植后早期组相比，PCr再合成率有显著改善（晚期27 +/- 6 mmol/L vs早期15 +/- 6 mmol/L/min，P <0.05）和统计学上无显著性的次极量运动pH改善趋势（晚期6.86 +/- 0.24 vs早期6.72 +/- 0.24）和次最大PCr/（PCr + Pi）比值（晚期0.56 +/- 0.14 vs早期0.44 +/- 0.15）和Vmax（晚期45 +/- 21 vs早期33 +/- 15 mmol/L/min）。然而，与正常受试者相比，移植后晚期组的运动持续时间和次最大PCr/（PCr + Pi）仍然减少。
结论
尽管心脏移植成功，但晚期心力衰竭的骨骼肌异常持续无限期，尽管在晚期出现部分改善。持续的异常可能导致大多数移植后患者的运动能力降低。
BACKGROUND
Patients with advanced heart failure have bioenergetic abnormalities of skeletal muscle metabolism during exercise. Using 31P magnetic resonance spectroscopy, we sought to determine whether skeletal metabolic responses to exercise are normalized by orthotopic cardiac transplantation.
METHODS AND RESULTS
Four groups were studied: healthy normal volunteers (n = 9), subjects awaiting heart transplantation (n = 10), subjects < 6 months (mean, 4 months) after transplant (n = 9), and subjects > 6 months (mean, 15 months) after transplant (n = 8). None of the posttransplant patients had biopsy evidence of rejection at the time of study. There were no significant differences in age, preoperative functional class, or symptom duration among the three patient groups. Metabolic responses were monitored in the dominant arm during incremental weight pull exercise and 10 minutes of recovery by 31P magnetic resonance spectroscopy, with measurement of pH and the phosphocreatine (PCr)/(PCr + inorganic phosphate [Pi]) ratio, an index of PCr concentration. In addition, based on recovery data, the rate of PCr resynthesis was calculated as a measure of oxidative metabolism that is independent of work level, recruitment, or muscle mass, and the effective maximal rate of mitochondrial ATP synthesis (Vmax) was determined. Analysis was by ANOVA. There were no differences between groups in pH or PCr/(PCr + Pi) at rest. Compared with the normal control group, the pretransplant group had a decreased exercise duration (11.3 +/- 2.5 versus 15.0 +/- 1.3 minutes, P = .02), a lower submaximal exercise PCr/(PCr + Pi) ratio (0.58 +/- 0.11 versus 0.76 +/- 0.08, P < .05), a reduced PCr resynthesis rate (13 +/- 6 versus 22 +/- 9 mmol/L per minute, P < .05), and a lower calculated Vmax (26 +/- 14 versus 53 +/- 26 mmol/L per minute, P < .05). In the group studied early after transplantation, all the changes noted in the pretransplant group persisted and were if anything somewhat worse. In the group studied late after transplantation, there was a significant improvement in the PCr resynthesis rate compared with the early-posttransplant group (27 +/- 6 late versus 15 +/- 6 mmol/L per minute early, P < .05) and statistically nonsignificant trends toward improvements in submaximal exercise pH (6.86 +/- 0.24 late versus 6.72 +/- 0.24 early) and submaximal PCr/(PCr + Pi) ratio (0.56 +/- 0.14 late versus 0.44 +/- 0.15 early) and Vmax (45 +/- 21 late versus 33 +/- 15 mmol/L per minute early). However, compared with normal subjects, exercise duration and submaximal PCr/(PCr + Pi) were still reduced in the late-posttransplant group.
CONCLUSIONS
Despite successful heart transplantation, skeletal muscle abnormalities of advanced heart failure persist for indefinite periods, although partial improvement occurred at late times. The persistent abnormalities may contribute to the reduced exercise capacity that is present in most patients after transplantation.
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影响因子：
37.8
作者：
MASSIE, B;CONWAY, M;RAJAGOPALAN, B
通讯作者：
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DOI：
10.1016/0002-9149(88)90129-4
发表时间：
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期刊：
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DOI：
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DOI：
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影响因子：
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DOI：
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发表时间：
1988
期刊：
The American journal of cardiology
影响因子：
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