Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Skeletal muscle function at low work level as a model for daily activities in patients with chronic heart failure
Fondazione S. Maugeri, Institute of Care and Research, Heart Failure Unit Montescano (PV), Italy
*Cardiovascular Research Center Gussago, Italy
Clinical Lab., Opera Pia P Richiedei Gussago (BS), Italy
Received 29 April 1997; accepted 5 May 1997.
Correspondence: Dr Christina Opasich, V. per Montescano, 27040 Montescano (PV)-I, Italy
Abstract
AIM: Metabolic exercise abnormalities have been reported in chronic heart failure patients. This study sought to evaluate whether these abnormalities affected daily activity.
METHODS AND RESULTS: In 16 patients with moderate-to-severe chronic heart failure and in eight controls we measured femoral flow (thermodilution) and metabolism (glucose, lactate, free fatty acids, blood gas values) at rest and during a constant load of 20 W, which may mimic a daily activity. At rest, chronic heart failure patients had a leg flow similar to controls, but showed a higher leg oxygen consumption (4·6±0· vs 2·6±0·4 ml. min–1; P>0·05), a higher arteriovenous oxygen difference (7·2±0·5 vs 5·4±0·7 ml . d1–1; P>0·05), and a lower femoral vein pH (7·37±5·–03 vs 7·42±0·01; P=0·01). At 20 W, chronic heart failure patients had a leg flow similar to controls, but showed increased lactate release (from resting 11·7±33 to 142+125 µg . min–1 P>0·0001 vs controls, from resting 5·7±15·4 to 50±149 µg . min–1 ns), higher arterial concentration of free fatty acids (781±69 vs 481±85 µmol . 1–1; P>0·01), lower femoral vein HCO3 (24·1+2·6 vs 26·3±1·7 mmol .1–1;P>0·05) and base excess (–2·3+2·3 vs –0·24±1·7 mmol . 1–1 P=0·01
CONCLUSION: In chronic heart failure patients, the important cellular metabolic alterations already present at rest partially affect daily activities, owing to a further decrease in the efficiency of muscle metabolic processes, and may preclude tolerance of heavier activities. Such alterations appear, at least in part, independent of peripheral haemodynamic responses to exercise.
Key Words: Chronic heart failure • peripheral metabolism • daily life
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