Detection of skeletal muscle fatigue in patients with heart failure using electromyography

Wilson, John R.; Mancini, Donna; Simson, Michael B.; Rein, Andrea; Farrell, Laura

doi:10.1016/0002-9149(92)91195-a

Cited by 25 publications

(8 citation statements)

References 10 publications

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“…(table 3, fig. 1) In ambulatory patients with heart failure, fatigue is probably a more important limiting factor than dyspnea [19]. which was in line with our finding that termination as a result of leg tiredness was significantly more common in patients with depressed LVEF.…”

Section: Discussionsupporting

confidence: 88%

Prediction of Left Ventricular Dysfunction in Coronary Artery Disease from Clinical and Exercise Test Findings

Sjöland¹,

Herlítz²,

Lamm

et al. 1997

Cardiology

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We studied the ability to predict depressed left ventricular ejection fraction (LVEF) from clinical and exercise test findings prior to surgery in consecutive patients who underwent coronary artery bypass grafting (CABG) from 1988 to 1991 (n = 663). Multivariate analysis showed a history of myocardial infarction, pathological Q-wave in resting ECG, systolic blood pressure at maximal exercise and the degree of mitral regurgitation as significant independent predictors of impaired LVEF. The relative risk (RR) of depressed LVEF was markedly increased for a previous history of myocardial infarction (RR 3.3, p < 0.0001) and a pathological Q-wave in resting ECG (RR 2.4, p < 0.0001). All associations found between depressed LVEF and exercise test results were poor, and of little value for discriminating patients with depressed LVEF. Thus, clinical data appear to be better markers of low LVEF than the information obtained from the exercise test.

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Section: Discussionsupporting

confidence: 88%

Prediction of Left Ventricular Dysfunction in Coronary Artery Disease from Clinical and Exercise Test Findings

Sjöland¹,

Herlítz²,

Lamm

et al. 1997

Cardiology

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“…Exercise capacity in heart failure patients is related to both muscle strength and bulk [30 32]. CHF is associated with a loss of muscle bulk from an early stage in the progression of the disease [33], and muscle strength [34] and endurance are reduced [35,36], independent of blood flow [35,37] and central factors [36].…”

Section: Discussionmentioning

confidence: 99%

Dyspnoea versus fatigue: Additional prognostic information from symptoms in chronic heart failure?

Witte

Clark

2008

European J of Heart Fail

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Background: In non-heart failure populations, dyspnoea reported by the patient as the reason for stopping an exercise test is associated with a worse prognosis than fatigue. Patients with chronic heart failure (CHF) have exercise limitation due to breathlessness or fatigue, but it is unclear whether one symptom confers an adverse prognosis over the other. Methods: Consecutive CHF patients underwent exercise testing with metabolic gas exchange. Upon stopping exercise the dominant symptom reported by the patients was recorded. Survival analyses were performed to establish predictors of mortality and relationships between symptoms and objective measures of exercise capacity. Results: Data were analysed on 271 patients (219 men), mean age 67 (10) years, mean left ventricular ejection fraction 32 (8)%, and median follow-up 59 months (interquartile range 38). There were no differences in exercise variables, sex, NYHA class, body mass index and medical therapy between fatigued and dyspnoeic patients. At the censor date 92 (34%) patients had died. Deceased patients had a lower peak oxygen consumption (17.2 (4.6) versus 20.3 (5.6); p = 0.0028). Although NYHA class was related to death at 36 months (χ 2 value = 7.3, p = 0.026), reason for stopping was not (χ 2 value = 0.57, p = 0.45). Conclusion: Unlike in non-heart failure populations, dyspnoea as the reason for stopping an exercise test in CHF subjects is not associated with increased mortality. CHF patients should be assessed for treatments such as cardiac resynchronisation therapy by the degree of exercise intolerance, not the nature of their symptoms.

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“…Importantly, the key role in limiting HF patients' sub-maximal and maximal exercise performance is attributed to increased skeletal muscle fatigability, which has already been demonstrated for HF as long as three decades ago [18][19][20][21][22][23]. There is evidence that early and extensive skeletal muscle fatigue in HF results from intrinsic pathology of this tissue rather than insufficient perfusion, decreased cardiac reserve, or abnormal neural signaling [19,20,23,24]. Although skeletal myopathy constitutes an important pathophysiological feature of HF, the precise mechanisms underlying muscular changes are not fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…The complex and multifaceted skeletal and respiratory myopathy constitutes an important element of HF pathophysiology [17,18], and muscle dysfunction contributes to the symptomatology of HF [8]. Importantly, the key role in limiting HF patients' sub-maximal and maximal exercise performance is attributed to increased skeletal muscle fatigability, which has already been demonstrated for HF as long as three decades ago [18][19][20][21][22][23]. There is evidence that early and extensive skeletal muscle fatigue in HF results from intrinsic pathology of this tissue rather than insufficient perfusion, decreased cardiac reserve, or abnormal neural signaling [19,20,23,24].…”

Section: Discussionmentioning

confidence: 99%

Iron status, catabolic/anabolic balance, and skeletal muscle performance in men with heart failure with reduced ejection fraction

Tkaczyszyn

Drozd

Węgrzynowska‐Teodorczyk

et al. 2021

Cardiol J.

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Background: Metabolic derangements related to tissue energetics constitute an important pathophysiological feature of heart failure. We investigated whether iron deficiency and catabolic/anabolic imbalance contribute to decreased skeletal muscle performance in men with heart failure with reduced ejection fraction (HFrEF), and whether these pathologies are related to each other. Methods: We comprehensively examined 23 men with stable HFrEF (median age [interquartile range]: 63 [59-66] years; left ventricular ejection fraction: 28 [25-35]%; New York Heart association class I/II/III: 17/43/39%). We analyzed clinical characteristics, iron status, hormones, strength and fatigability of forearm flexors and quadriceps (surface electromyography), and exercise capacity (6-minute walking test). Results: None of the patients had anemia whereas 8 were iron-deficient. Flexor carpi radialis fatigability correlated with lower reticulocyte hemoglobin content (CHR, p < 0.05), and there was a trend towards greater fatigability in patients with higher body mass index and lower serum ferritin (both p < 0.1). Flexor carpi ulnaris fatigability correlated with lower serum iron and CHR (both p < 0.05). Vastus medialis fatigability was related to lower free and bioavailable testosterone (FT and BT, respectively, both p < 0.05), and 6MWT distance was shorter in patients with higher cortisol/FT and cortisol/BT ratio (both p < 0.05). Lower ferritin and transferrin saturation correlated with lower percentage of FT and BT. Men with HFrEF and ID had higher total testosterone, but lower percentage of FT and BT. Conclusions: Iron deficiency correlates with lower bioactive testosterone in men with HFrEF. These two pathologies can both contribute to decreased skeletal muscle performance in such patients.

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Detection of skeletal muscle fatigue in patients with heart failure using electromyography

Cited by 25 publications

References 10 publications

Prediction of Left Ventricular Dysfunction in Coronary Artery Disease from Clinical and Exercise Test Findings

Prediction of Left Ventricular Dysfunction in Coronary Artery Disease from Clinical and Exercise Test Findings

Dyspnoea versus fatigue: Additional prognostic information from symptoms in chronic heart failure?

Iron status, catabolic/anabolic balance, and skeletal muscle performance in men with heart failure with reduced ejection fraction

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