Skip to main content
PMC home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1991 Dec;88(6):2077–2082. doi: 10.1172/JCI115537

Impaired skeletal muscle function in patients with congestive heart failure. Relationship to systemic exercise performance.

J R Minotti 1, I Christoph 1, R Oka 1, M W Weiner 1, L Wells 1, B M Massie 1
PMCID: PMC295805  PMID: 1752965

Abstract

In patients with congestive heart failure (CHF), the poor relationship between systemic exercise performance and cardiac function, together with morphologic and metabolic abnormalities in skeletal muscle, raises the possibility that skeletal muscle function may be impaired and limit systemic exercise performance. We assessed strength and endurance of the knee extensors during static and dynamic exercise in 16 patients with Class I-IV CHF and eight age-matched sedentary controls and related these measurements to systemic exercise performance. To assess skeletal muscle function independent of peripheral blood flow, endurance was repeated under ischemic conditions. Strength was not significantly different in the two groups. Dynamic endurance, quantified as the decline in peak torque during 15 successive isokinetic knee extensions, was significantly reduced in the patients compared to controls during aerobic (peak torque 65 vs. 86% of initial for exercise at 90 deg/s and 60 vs. 85% for exercise at 180 deg/s; P less than 0.002 for both), and during ischemic exercise (56 vs. 76% of initial torque; P less than 0.01). Static endurance, defined as the time required for force during a sustained maximal voluntary contraction to decline to 60% of maximal, was reduced in the patients compared to controls (40 +/- 14 vs. 77 +/- 29 s; P less than 0.02). There were highly significant relationships between systemic exercise performance and skeletal muscle endurance at 90 and 180 deg/s in the patients with CHF (r = 0.90 and 0.66, respectively). These findings indicate that skeletal muscle endurance is impaired in patients with CHF, that this abnormality is in part independent of limb blood flow, and that these changes may be important determinants of systemic exercise performance.

Full text

PDF
2079

Images in this article

2079Image
on p.2079

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Franciosa J. A., Ziesche S., Wilen M. Functional capacity of patients with chronic left ventricular failure. Relationship of bicycle exercise performance to clinical and hemodynamic characterization. Am J Med. 1979 Sep;67(3):460–466. doi: 10.1016/0002-9343(79)90794-0. [DOI] [PubMed] [Google Scholar]
  2. Higginbotham M. B., Morris K. G., Conn E. H., Coleman R. E., Cobb F. R. Determinants of variable exercise performance among patients with severe left ventricular dysfunction. Am J Cardiol. 1983 Jan 1;51(1):52–60. doi: 10.1016/s0002-9149(83)80010-1. [DOI] [PubMed] [Google Scholar]
  3. Larsson L., Karlsson J. Isometric and dynamic endurance as a function of age and skeletal muscle characteristics. Acta Physiol Scand. 1978 Oct;104(2):129–136. doi: 10.1111/j.1748-1716.1978.tb06259.x. [DOI] [PubMed] [Google Scholar]
  4. LeJemtel T. H., Maskin C. S., Lucido D., Chadwick B. J. Failure to augment maximal limb blood flow in response to one-leg versus two-leg exercise in patients with severe heart failure. Circulation. 1986 Aug;74(2):245–251. doi: 10.1161/01.cir.74.2.245. [DOI] [PubMed] [Google Scholar]
  5. Lipkin D. P., Jones D. A., Round J. M., Poole-Wilson P. A. Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol. 1988 Feb;18(2):187–195. doi: 10.1016/0167-5273(88)90164-7. [DOI] [PubMed] [Google Scholar]
  6. Lipkin D. P., Poole-Wilson P. A. Symptoms limiting exercise in chronic heart failure. Br Med J (Clin Res Ed) 1986 Apr 19;292(6527):1030–1031. doi: 10.1136/bmj.292.6527.1030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. MITCHELL J. H., SPROULE B. J., CHAPMAN C. B. The physiological meaning of the maximal oxygen intake test. J Clin Invest. 1958 Apr;37(4):538–547. doi: 10.1172/JCI103636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Massie B., Conway M., Yonge R., Frostick S., Ledingham J., Sleight P., Radda G., Rajagopalan B. Skeletal muscle metabolism in patients with congestive heart failure: relation to clinical severity and blood flow. Circulation. 1987 Nov;76(5):1009–1019. doi: 10.1161/01.cir.76.5.1009. [DOI] [PubMed] [Google Scholar]
  9. Miller R. G., Boska M. D., Moussavi R. S., Carson P. J., Weiner M. W. 31P nuclear magnetic resonance studies of high energy phosphates and pH in human muscle fatigue. Comparison of aerobic and anaerobic exercise. J Clin Invest. 1988 Apr;81(4):1190–1196. doi: 10.1172/JCI113434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Minotti J. R., Johnson E. C., Hudson T. L., Zuroske G., Murata G., Fukushima E., Cagle T. G., Chick T. W., Massie B. M., Icenogle M. V. Skeletal muscle response to exercise training in congestive heart failure. J Clin Invest. 1990 Sep;86(3):751–758. doi: 10.1172/JCI114771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Mitchell J. H., Blomqvist G. Maximal oxygen uptake. N Engl J Med. 1971 May 6;284(18):1018–1022. doi: 10.1056/NEJM197105062841809. [DOI] [PubMed] [Google Scholar]
  12. Sahlin K., Edström L., Sjöholm H. Fatigue and phosphocreatine depletion during carbon dioxide-induced acidosis in rat muscle. Am J Physiol. 1983 Jul;245(1):C15–C20. doi: 10.1152/ajpcell.1983.245.1.C15. [DOI] [PubMed] [Google Scholar]
  13. Sahlin K., Edström L., Sjöholm H., Hultman E. Effects of lactic acid accumulation and ATP decrease on muscle tension and relaxation. Am J Physiol. 1981 Mar;240(3):C121–C126. doi: 10.1152/ajpcell.1981.240.3.C121. [DOI] [PubMed] [Google Scholar]
  14. Sullivan M. J., Higginbotham M. B., Cobb F. R. Exercise training in patients with severe left ventricular dysfunction. Hemodynamic and metabolic effects. Circulation. 1988 Sep;78(3):506–515. doi: 10.1161/01.cir.78.3.506. [DOI] [PubMed] [Google Scholar]
  15. Szlachcic J., Massie B. M., Kramer B. L., Topic N., Tubau J. Correlates and prognostic implication of exercise capacity in chronic congestive heart failure. Am J Cardiol. 1985 Apr 1;55(8):1037–1042. doi: 10.1016/0002-9149(85)90742-8. [DOI] [PubMed] [Google Scholar]
  16. Tesch P., Sjödin B., Thorstensson A., Karlsson J. Muscle fatigue and its relation to lactate accumulation and LDH activity in man. Acta Physiol Scand. 1978 Aug;103(4):413–420. doi: 10.1111/j.1748-1716.1978.tb06235.x. [DOI] [PubMed] [Google Scholar]
  17. Thorstensson A., Grimby G., Karlsson J. Force-velocity relations and fiber composition in human knee extensor muscles. J Appl Physiol. 1976 Jan;40(1):12–16. doi: 10.1152/jappl.1976.40.1.12. [DOI] [PubMed] [Google Scholar]
  18. Wahren J., Jorfeldt L. Determination of leg blood flow during exercise in man: an indicator-dilution technique based on femoral venous dye infusion. Clin Sci Mol Med. 1973 Aug;45(2):135–146. doi: 10.1042/cs0450135. [DOI] [PubMed] [Google Scholar]
  19. Wiener D. H., Fink L. I., Maris J., Jones R. A., Chance B., Wilson J. R. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation. 1986 Jun;73(6):1127–1136. doi: 10.1161/01.cir.73.6.1127. [DOI] [PubMed] [Google Scholar]
  20. Wilson J. R., Ferraro N. Exercise intolerance in patients with chronic left heart failure: relation to oxygen transport and ventilatory abnormalities. Am J Cardiol. 1983 May 1;51(8):1358–1363. doi: 10.1016/0002-9149(83)90312-0. [DOI] [PubMed] [Google Scholar]
  21. Wilson J. R., Fink L., Maris J., Ferraro N., Power-Vanwart J., Eleff S., Chance B. Evaluation of energy metabolism in skeletal muscle of patients with heart failure with gated phosphorus-31 nuclear magnetic resonance. Circulation. 1985 Jan;71(1):57–62. doi: 10.1161/01.cir.71.1.57. [DOI] [PubMed] [Google Scholar]
  22. Wilson J. R., Martin J. L., Ferraro N. Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol. 1984 May 1;53(9):1308–1315. doi: 10.1016/0002-9149(84)90085-7. [DOI] [PubMed] [Google Scholar]
  23. Zelis R., Longhurst J., Capone R. J., Mason D. T. A comparison of regional blood flow and oxygen utilization during dynamic forearm exercise in normal subjects and patients with congestive heart failure. Circulation. 1974 Jul;50(1):137–143. doi: 10.1161/01.cir.50.1.137. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES