Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure.

Jondeau, Guillaume; Katz, Stuart D.; Zohman, Lenore R.; Goldberger, M.; McCarthy, Melissa; Bourdarias, Jean-Pierre; LeJemtel, Thierry H.

doi:10.1161/01.cir.86.5.1351

Cited by 129 publications

(56 citation statements)

References 39 publications

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“…Furthermore, the intramuscular pH was more severely lowered in the CHF patients than in controls. 15 Taken together with the findings from Jondeau et al 20 and LeJemtel, skeletal muscle metabolism reaches its limit at the end of exercise, even with considerable cardiac reserve, in patients with CHF. 15, 20 Thus, skeletal muscle metabolism limits the exercise capacity of CHF patients.…”

Section: Does Skeletal Muscle Metabolism Limit Exercise Capacity In Chf?mentioning

confidence: 79%

Exercise Intolerance in Chronic Heart Failure

Okita

Kinugawa

Tsutsui

2013

Circ J

106

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Chronic heart failure (CHF) is characterized as a clinical disorder displaying exercise intolerance; patients typically complain of early muscular fatigue. Previously, it was thought to be simply a failure of perfusion to the exercising musculature and consequent early onset of intramuscular acidosis in CHF. However, improved hemodynamics by cardiotonic agents did not lead to an increase in exercise tolerance. Later studies have shown that intrinsic skeletal muscle abnormalities exist in patients with CHF and could induce the early anaerobic metabolism that limits exercise tolerance. We review the clinical importance of skeletal muscle abnormalities in patients with CHF. Considering the significance of peripheral muscle abnormalities and their development might help physicians and researchers better understand the mechanisms of well-established exercise training and pharmacological therapies that have been shown to improve the prognosis for CHF, and thus develop potential novel therapies. (Circ J 2013; 77: 293 -300)

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Section: Does Skeletal Muscle Metabolism Limit Exercise Capacity In Chf?mentioning

confidence: 79%

Exercise Intolerance in Chronic Heart Failure

Okita

Kinugawa

Tsutsui

2013

Circ J

106

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“…Second, the patients enrolled in this study had mild CHF, so the various relationships observed in this study may not be applicable to moderate to severe CHF 16 in which there is not only impaired pump function but also quantitative and qualitative changes of the skeletal muscle that may strongly affect exercise capacity. 9 Third, the correlations among variables as shown in Fig 2 should each be primarily evaluated in normal subjects and CHF patients. In this study, each relationship among the variables was evaluated together because of the small population, and considering a continuous group from sedentary volunteers to mild CHF patients.…”

Section: Study Limitationsmentioning

confidence: 99%

“…In the present study, we compared normal subjects with patients with mild CHF because Jandeau et al 9 has previously demonstrated that the limiting factor for exercise capacity is cardiopulmonary reserve in both groups, but is peripheral muscle itself in patients with moderate to severe CHF. 9 We hypothesized that redistribution of blood flow from the non-exercising tissues to the working skeletal muscle during exercise would be blunted, in addition to impairment of the exercise-induced reduction of systemic vascular resistance (SVR), possibly leading to a reduction in the exercise capacity of patients with mild CHF.…”

mentioning

confidence: 99%

“…9 We hypothesized that redistribution of blood flow from the non-exercising tissues to the working skeletal muscle during exercise would be blunted, in addition to impairment of the exercise-induced reduction of systemic vascular resistance (SVR), possibly leading to a reduction in the exercise capacity of patients with mild CHF. To assess this, we noninvasively and continuously measured cardiac output (CO), forearm blood flow and blood pressure (BP) during a symptom-limited graded bicycle exercise test in both normal subjects and patients with mild CHF.…”

mentioning

confidence: 99%

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Vasoconstrictive Response in the Vascular Beds of the Non-Exercising Forearm During Leg Exercise in Patients With Mild Chronic Heart Failure

Chiba

Maehara

Yaoita

et al. 2007

Circ J

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Background Reduced exercise capacity may be related to decreased redistribution of blood flow from the nonexercising tissues to the exercising skeletal muscle in patients with mild chronic heart failure (CHF). Methods and ResultsIn the present study 14 patients with mild CHF and 10 healthy subjects (N) underwent symptom-limited multistage-ergometer exercise, during which forearm vascular resistance (FVR), cardiac index (CI), systemic vascular resistance index (SVRI), and oxygen uptake (V • O2) were measured non-invasively using the plethysmograph, impedance, and respiratory gas analysis methods, respectively. The V • O2 and CI at peak exercise were lower (p<0.01 each), and SVRI and FVR at both rest and peak exercise were higher in the CHF group than in N. However, both the percent increase in FVR and percent decrease in SVRI from the resting state to peak exercise were lower in CHF than N, and both of them correlated with not only peak V• O2, but also the corresponding resting value of FVR and SVRI (p<0.01 each). Conclusions Redistribution of blood flow from the non-exercising tissues to the working skeletal muscles, which may participate in exercise capacity, can be blunted in CHF. The decreased vasoconstrictive response in the non-exercising tissues is intimately related to the increased resting vascular tone in CHF. (Circ J 2007; 71: 922 -928)

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“…[14][15][16][17] Além disso, o aumento no débito cardíaco agudo provocado por drogas não melhora a tolerância aos esforços físicos na insuficiência cardíaca. 18,19 Por fim, Jondeau et al (1992) 20 mostraram em um estudo bem delineado que as lesões periféricas, e não a redução no débito cardí-aco, limitam a maioria dos pacientes com insuficiên-cia cardíaca. Eles viram que a frequência cardíaca e o consumo de oxigênio aumentaram na maioria dos pacientes adicionando um exercício com os membros superiores após o consumo de oxigênio ter atingido platô em exercício em bicicleta até a exaustão.…”

Section: Introductionunclassified

Relevância e tratamento das lesões características da insuficiência cardíaca na musculatura esquelética

Júnior

2009

Medicina (Ribeirão Preto)

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Pacientes com insuficiência cardíaca, a via final das doenças cardiovasculares e a primeira causa de internação em idosos no Brasil, apresentam deterioração do tecido muscular esquelético. Além disso, as lesões na musculatura têm relação direta com a qualidade de vida e a autonomia dos pacientes, por meio do nível de tolerância aos esforços físicos, além de constituírem um preditor independente de mortalidade na síndrome. Ao longo da presente revisão de literatura serão discutidos em relação à insuficiência cardíaca: seu conceito e um breve histórico; a importância da musculatura esquelética; as anormalidades funcionais, estruturais, bioquímicos e moleculares que acometem esse tecido; as potenciais causas dessas alterações (hiperatividade simpática, redução na ingestão alimentar, espécies reativas de oxigênio, citocinas pró-inflamatórias e diminuição do nível de atividade física e do fluxo sanguíneo); e os efeitos da principal terapia direcionada para combater essa disfunção, o treinamento físico aeróbio de intensidade moderada. Reconhecida a importância do tecido muscular esquelético na síndrome, essa é uma área da investigação científica com muitos temas ainda não estudados, como o efeito de terapias farmacológicas utilizadas pelos pacientes, de exercícios físicos aeróbios de maior intensidade e intervalados, de exercícios físicos de força, de intervenções nutricionais e de terapias celulares e gênicas. No futuro, os resultados desses estudos que serão desenvolvidos certamente contribuirão para uma menor degeneração da musculatura esquelética na doença, o que, consequentemente, vai melhorar a ualidade de vida, a autonomia e o prognóstico dos pacientes.

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Active skeletal muscle mass and cardiopulmonary reserve. Failure to attain peak aerobic capacity during maximal bicycle exercise in patients with severe congestive heart failure.

Abstract: In contrast to normal subjects and patients with moderate CHF, patients with severe CHF do not exhaust their cardiopulmonary reserve during symptom-limited maximal LL exercise on a bicycle.

Cited by 129 publications

References 39 publications

Exercise Intolerance in Chronic Heart Failure

Exercise Intolerance in Chronic Heart Failure

Vasoconstrictive Response in the Vascular Beds of the Non-Exercising Forearm During Leg Exercise in Patients With Mild Chronic Heart Failure

Relevância e tratamento das lesões características da insuficiência cardíaca na musculatura esquelética

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