Reduced exercise tolerance in CHF may be related to factors other than impaired skeletal muscle oxidative capacity

Williams, Andrew D.; Selig, Steve E; Hare, David; Hayes, Alan; Krum, Henry; Patterson, Jeremy A.; Geerling, Ralph; Toia, Deidre; Carey, Michael

doi:10.1016/j.cardfail.2003.09.004

Cited by 61 publications

(59 citation statements)

References 40 publications

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“…Peak total body oxygen consumption ( Plasma lactate levels were determined and lactate threshold calculated using a log-log transformation plot of plasma lactate concentration versus power output as previously described (21,22).…”

Section: Exercise Testingmentioning

confidence: 99%

Differential response to resistance training in CHF according to ACE genotype

Williams

Anderson

Selig

et al. 2011

International Journal of Cardiology

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Section: Exercise Testingmentioning

confidence: 99%

Differential response to resistance training in CHF according to ACE genotype

Williams

Anderson

Selig

et al. 2011

International Journal of Cardiology

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“…It is known that aging results in alterations in skeletal muscle, including a reduction in the relative number of type II fibers (40) and in capillary density (9), and that these are associated with a decline in physical performance (51). Furthermore, it is well established that patients with HF with reduced ejection fraction (HFREF) have multiple skeletal muscle abnormalities (12,39,42,43,45,58,64,66,72), including a reduced percentage of type I (oxidative) fibers and a decreased number of capillaries per fiber, and that these contribute significantly to their severe exercise intolerance (49,64,65). However, despite the high prevalence of HFPEF and the impact of exercise intolerance as its key chronic symptom, there is no information available regarding skeletal muscle phenotype and its relationship to peak V O 2 in HFPEF.…”

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confidence: 99%

Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction

Kitzman

Nicklas

Kraus

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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Kitzman DW, Nicklas B, Kraus WE, Lyles MF, Eggebeen J, Morgan TM, Haykowsky M. Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ Physiol 306: H1364-H1370, 2014. First published March 21, 2014 doi:10.1152/ajpheart.00004.2014.-Heart failure (HF) with preserved ejection fraction (HFPEF) is the most common form of HF in older persons. The primary chronic symptom in HFPEF is severe exercise intolerance, and its pathophysiology is poorly understood. To determine whether skeletal muscle abnormalities contribute to their severely reduced peak exercise O2 consumption (V O2), we examined 22 older HFPEF patients (70 Ϯ 7 yr) compared with 43 age-matched healthy control (HC) subjects using needle biopsy of the vastus lateralis muscle and cardiopulmonary exercise testing to assess muscle fiber type distribution and capillarity and peak V O2. In HFPEF versus HC patients, peak V O2 (14.7 Ϯ 2.1 vs. 22.9 Ϯ 6.6 ml·kg Ϫ1 · min Ϫ1 , P Ͻ 0.001) and 6-min walk distance (454 Ϯ 72 vs. 573 Ϯ 71 m, P Ͻ 0.001) were reduced. In HFPEF versus HC patients, the percentage of type I fibers (39.0 Ϯ 11.4% vs. 53.7 Ϯ 12.4%, P Ͻ 0.001), type I-to-type II fiber ratio (0.72 Ϯ 0.39 vs. 1.36 Ϯ 0.85, P ϭ 0.001), and capillary-to-fiber ratio (1.35 Ϯ 0.32 vs. 2.53 Ϯ 1.37, P ϭ 0.006) were reduced, whereas the percentage of type II fibers was greater (61 Ϯ 11.4% vs. 46.3 Ϯ 12.4%, P Ͻ 0.001). In univariate analyses, the percentage of type I fibers (r ϭ 0.39, P ϭ 0.003), type I-to-type II fiber ratio (r ϭ 0.33, P ϭ 0.02), and capillary-to-fiber ratio (r ϭ 0.59, P Ͻ 0.0001) were positively related to peak V O2. In multivariate analyses, type I fibers and the capillary-to-fiber ratio remained significantly related to peak V O2. We conclude that older HFPEF patients have significant abnormalities in skeletal muscle, characterized by a shift in muscle fiber type distribution with reduced type I oxidative muscle fibers and a reduced capillary-to-fiber ratio, and these may contribute to their severe exercise intolerance. This suggests potential new therapeutic targets in this difficult to treat disorder. heart failure; exercise; aging APPROXIMATELY 50% OF HEART FAILURE (HF) patients living in the community have preserved left ventricular (LV) ejection fraction (HFPEF) (33,52,68). HFPEF is nearly exclusively a disorder of older persons and is most common in women. The primary symptom in patients with chronic HFPEF is severe exercise intolerance, measured objectively as decreased peak exercise O 2 uptake (peak V O 2 ) (2,3,5,26,30,34,35,41), and this is associated with a reduced quality of life. Despite its importance, the pathophysiology of exercise intolerance in HFPEF is not well understood.Several lines of evidence suggest that in older HFPEF patients, noncardiac factors may contribute to reduced peak V O 2 and may be major contributors to the improvement in peak V O 2 after endurance exercise training (2,5,23,24,26,36,47,54). It is known that aging results in alter...

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“…These peripheral changes include extensive morphological and functional abnormalities of skeletal muscles, especially loss of muscle mass, decreased number of type I (slow fibers), and reduced terminal microcirculation density 4,5 . At the metabolic level, muscular abnormalities are characterized by a decrease in the number of mitochondria and decline in their oxidation capacity [6][7][8] . Current treatment of heart failure (CHF) encompasses not only appropriate pharmacotherapy but also meticulous education consisting in changing patient's life style and performing adequate physical activity 9 .…”

Section: Introductionmentioning

confidence: 99%

Exercise training combined with electromyostimulation in the rehabilitation of patients with chronic heart failure: A randomized trial

Soška¹,

Dobšák²,

Pohanka³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Reduced exercise tolerance in CHF may be related to factors other than impaired skeletal muscle oxidative capacity

Abstract: Background. We sought to determine whether skeletal muscle oxidative capacity, fiber

Cited by 61 publications

References 40 publications

Differential response to resistance training in CHF according to ACE genotype

Differential response to resistance training in CHF according to ACE genotype

Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction

Exercise training combined with electromyostimulation in the rehabilitation of patients with chronic heart failure: A randomized trial

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