SKELETAL-MUSCLE METABOLISM DURING EXERCISE UNDER ISCHEMIC CONDITIONS IN CONGESTIVE HEART-FAILURE - EVIDENCE FOR ABNORMALITIES UNRELATED TO BLOOD-FLOW
SKELETAL-MUSCLE METABOLISM DURING EXERCISE UNDER ISCHEMIC CONDITIONS IN CONGESTIVE HEART-FAILURE - EVIDENCE FOR ABNORMALITIES UNRELATED TO BLOOD-FLOW
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DOI：
10.1161/01.cir.78.2.320
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发表时间：
1988-08-01
期刊：
影响因子：
37.8
通讯作者：
RADDA, G
中科院分区：
文献类型：
--
作者：
MASSIE, BM;CONWAY, M;RADDA, G
先前的31P核磁共振研究表明，慢性充血性心力衰竭患者在运动骨骼肌时经常表现出糖酵解代谢增加和氧化磷酸化受损，但这些变化的机制仍未解决。进行这项研究的目的是确定这些异常是否是由于血流或氧气输送受损造成的。研究人员对九名患有轻度至中度充血性心力衰竭的患者和九名年龄和体型匹配的健康对照志愿者进行了有氧和缺血条件下重复次最大手指弯曲运动的研究。通过指浅屈肌的 31P 核磁共振评估骨骼肌代谢。在以每位受试者预定最大工作量的 33% 进行稳态有氧运动期间，充血性心力衰竭患者表现出显着较低的 pH 值（6.65 .+-. 0.22 与 6.97 .+-. 0.09，p < 0.002）和磷酸肌酸浓度，表示为 [磷酸肌酸]/（[磷酸肌酸]+[无机磷酸盐]）（0.59） .+-.0.14 与 0.79.+-.0.08，p < 0.002）。在相同负荷下的缺血性运动中也存在类似的差异。根据这些测量结果，计算得出的乳酸产量和 5''-三磷酸腺苷消耗率在充血性心力衰竭患者中显着较高。这些结果表明，在许多患有充血性心力衰竭的患者中，锻炼肌肉表现出糖酵解代谢增加，并且与外部工作相比，代谢效率似乎较低。这些变化不能仅用血流或氧气输送受损来解释。
Previous studies with 31P nuclear magnetic resonance have demonstrated that patients with chronic congestive heart failure often exhibit increased glycolytic metabolism and impaired oxidative phosphorylation in exercising skeletal muscle, but the mechanism for these changes remains unresolved. This study was conducted to determine whether these abnormalities result from impaired blood flow or oxygen delivery. Nine patients with mild-to-moderate congestive heart failure and nine age- and size-matched, healthy control volunteers were studied during repetitive submaximal finger flexion exercise under aerobic and ischemic conditions. Skeletal muscle metabolism was assessed by 31P nuclear magnetic resonance of the flexor digitorum superficialis muscle. During steady-state aerobic exercise at 33% of each subject''s predetermined maximum workload, the patients with congestive heart failure exhibited significantly lower pH values (6.65 .+-. 0.22 vs. 6.97 .+-. 0.09, p < 0.002) and phosphocreatine concentrations, expressed as [phosphocreatine]/([phosphocreatine]+[inorganic phosphate]) (0.59 .+-. 0.14 vs. 0.79 .+-. 0.08, p < 0.002). Similar differences were also present throughout ischemic exercise at the same workload. Based upon these measurements, calculated lactate production and adenosine 5''-triphosphate consumption rates were significantly higher in the patients with congestive heart failure. These results indicate that in many patients with congestive heart failure exercising muscle exhibits increased glycolytic metabolism and appears to be metabolically less efficient in relation to external work performed. These changes cannot be explained by impaired blood flow or oxygen delivery alone.