Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
The influence of muscle mass, strength, fatigability and blood flow on exercise capacity in cachectic and non-cachectic patients with chronic heart failure
,
*Department of cardiac Medicine, Imperial College and Royal Brompton Hospital London, U.K.
Department of Cardiology, Universitätsklinikum Charité, Humboldt University Berlin Berlin, Germany
Southern General Hospital NHS Trust Glasgow, U.K.
revised 9 April 1996; accepted 11 April 1996.
Correspondence: Dr Stefan Anker, c/o Dr Andrew Coats, Department of Cardiac Medicine, National Heart and Lung Institute London, Dovehouse Street, London SW3 6LY, U.K.
Abstract
BACKGROUND: The influence of age, skeletal muscle function and peripheral blood flow on exercise capacity in chronic heart failure patients is controversial, possibly due to variations in skeletal muscle atrophy.
METHODS AND RESULTS: To assess predictors of exercise capacity in patients with clinical cardiac cachexia, we studied 16 cachectic and 39 non-cachectic male chronic heart failure patients of similar age and ejection fraction. All cachectic patients were wasted (% ideal body weight: 81 1·9 vs 105·2±2·1, P<0· mean±SEM) and had documented weight loss (5–30 kg). Peak oxygen consumption (14·9±1·4 vs 16·3±0·6 ml.kg–1, min –1, resting, and peak blood flow (plethysmography) and 20 min fatigability (% baseline strength) were all similar between the two groups. Quadriceps strength, muscle size (all P<0·0001), strength per unit muscle (right: P<0·05; left: P<0·0·01) and 5 min fatigability (P<0·05) were all lower in cachectic patients. In non-cachectic patients, age (R=0·48 and quadriceps strength (R=0·43, all P<0·01) predicted peak oxygen consumption. Only in cachectic patients did peak blood flow predict peak oxygen consumption significantly (R=0·72, P0·005), whereas age and strength did not. Similar findings were confirmed using other previously published definitions of cardiac cachexia.
CONCLUSION: The predictors of exercise capacity change with the development of cardiac cachexia from age and strength to peak blood flow. This shift may be caused by additional endocrine or catabolic abnormalities active in end stage heart failure.
Key Words: Chronic heart failure • cardiac cachexia • maximal oxygen consumption • muscle strength • fatigability • leg blood flow
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. J. H. Sillen, C. M. Speksnijder, R.-M. A. Eterman, P. P. Janssen, S. S. Wagers, E. F. M. Wouters, N. H. M. K. Uszko-Lencer, and M. A. Spruit Effects of Neuromuscular Electrical Stimulation of Muscles of Ambulation in Patients With Chronic Heart Failure or COPD: A Systematic Review of the English-Language Literature Chest, July 1, 2009; 136(1): 44 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Jankowska, P. Rozentryt, B. Ponikowska, O. Hartmann, D. Kustrzycka-Kratochwil, K. Reczuch, J. Nowak, L. Borodulin-Nadzieja, L. Polonski, W. Banasiak, et al. Circulating Estradiol and Mortality in Men With Systolic Chronic Heart Failure JAMA, May 13, 2009; 301(18): 1892 - 1901. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Doehner, A. C. Bunck, M. Rauchhaus, S. von Haehling, F. M. Brunkhorst, M. Cicoira, C. Tschope, P. Ponikowski, R. A. Claus, and S. D. Anker Secretory sphingomyelinase is upregulated in chronic heart failure: a second messenger system of immune activation relates to body composition, muscular functional capacity, and peripheral blood flow Eur. Heart J., April 1, 2007; 28(7): 821 - 828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Bayes-Genis, D. M. Lloyd-Jones, R. R. J. van Kimmenade, J. G. Lainchbury, A. M. Richards, J. Ordonez-Llanos, M. Santalo, Y. M. Pinto, and J. L. Januzzi Jr Effect of Body Mass Index on Diagnostic and Prognostic Usefulness of Amino-Terminal Pro-Brain Natriuretic Peptide in Patients With Acute Dyspnea Arch Intern Med, February 26, 2007; 167(4): 400 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Doehner, M. Rauchhaus, P. Ponikowski, I. F. Godsland, S. von Haehling, D. O. Okonko, F. Leyva, A. J. Proudler, A. J.S. Coats, and S. D. Anker Impaired Insulin Sensitivity as an Independent Risk Factor for Mortality in Patients With Stable Chronic Heart Failure J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1019 - 1026. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Linke, V. Adams, P. C. Schulze, S. Erbs, S. Gielen, E. Fiehn, S. Mobius-Winkler, A. Schubert, G. Schuler, and R. Hambrecht Antioxidative Effects of Exercise Training in Patients With Chronic Heart Failure: Increase in Radical Scavenger Enzyme Activity in Skeletal Muscle Circulation, April 12, 2005; 111(14): 1763 - 1770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M A Spruit, M J Thomeer, R Gosselink, T Troosters, A Kasran, A J T Debrock, M G Demedts, and M Decramer Skeletal muscle weakness in patients with sarcoidosis and its relationship with exercise intolerance and reduced health status Thorax, January 1, 2005; 60(1): 32 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hulsmann, M. Quittan, R. Berger, R. Crevenna, C. Springer, M. Nuhr, D. Mortl, P. Moser, and R. Pacher Muscle strength as a predictor of long-term survival in severe congestive heart failure Eur J Heart Fail, January 1, 2004; 6(1): 101 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Hinkle, E. Donnelly, D. B. Cody, S. Samuelsson, J. S. Lange, M. B. Bauer, M. Tarnopolsky, R. J. Sheldon, S. C. Coste, E. Tobar, et al. Activation of the CRF 2 receptor modulates skeletal muscle mass under physiological and pathological conditions Am J Physiol Endocrinol Metab, October 1, 2003; 285(4): E889 - E898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Lavie and R. V. Milani Obesity and cardiovascular disease: the hippocrates paradox? J. Am. Coll. Cardiol., August 20, 2003; 42(4): 677 - 679. [Full Text] [PDF]
|
|
|
|
|
|
H. R. Gosker, N. H. M. K. Lencer, F. M. E. Franssen, G. J. van der Vusse, E. F. M. Wouters, and A. M. W. J. Schols Striking Similarities in Systemic Factors Contributing to Decreased Exercise Capacity in Patients With Severe Chronic Heart Failure or COPD Chest, May 1, 2003; 123(5): 1416 - 1424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Reid, J. Lannergren, and H. Westerblad Respiratory and Limb Muscle Weakness Induced by Tumor Necrosis Factor-{alpha}: Involvement of Muscle Myofilaments Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 479 - 484. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Doehner, N. Schoene, M. Rauchhaus, F. Leyva-Leon, D. V. Pavitt, D. A. Reaveley, G. Schuler, A. J.S. Coats, S. D. Anker, and R. Hambrecht Effects of Xanthine Oxidase Inhibition With Allopurinol on Endothelial Function and Peripheral Blood Flow in Hyperuricemic Patients With Chronic Heart Failure: Results From 2 Placebo-Controlled Studies Circulation, June 4, 2002; 105(22): 2619 - 2624. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Sharma and S.D Anker From tissue wasting to cachexia: changes in peripheral blood flow and skeletal musculature Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D12 - D17. [Abstract] [PDF]
|
|
|
|
|
|
S. Nanas, J. Nanas, C. Kassiotis, C. Nikolaou, E. Tsagalou, D. Sakellariou, I. Terovitis, O. Papazachou, S. Drakos, A. Papamichalopoulos, et al. Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure Eur J Heart Fail, December 1, 2001; 3(6): 685 - 692. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. R Kalra, S. D Anker, and A. J.S Coats Water and sodium regulation in chronic heart failure: the role of natriuretic peptides and vasopressin Cardiovasc Res, August 15, 2001; 51(3): 495 - 509. [Full Text] [PDF]
|
|
|
|
|
|
S. D. Anker, M. Volterrani, C.-D. Pflaum, C. J. Strasburger, K. J. Osterziel, W. Doehner, M. B. Ranke, P. A. Poole-Wilson, A. Giustina, R. Dietz, et al. Acquired growth hormone resistance in patients with chronic heart failure: implications for therapy with growth hormone J. Am. Coll. Cardiol., August 1, 2001; 38(2): 443 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ponikowski, T. P. Chua, S. D. Anker, D. P. Francis, W. Doehner, W. Banasiak, P. A. Poole-Wilson, M. F. Piepoli, and A. J.S. Coats Peripheral Chemoreceptor Hypersensitivity: An Ominous Sign in Patients With Chronic Heart Failure Circulation, July 31, 2001; 104(5): 544 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wensel and S. D. Anker Lean tissue adjusted peak oxygen consumption in congestive heart failure J. Am. Coll. Cardiol., July 1, 2001; 38(1): 287 - 288. [Full Text] [PDF]
|
|
|
|
|
|
M. Cicoira, L. Zanolla, L. Franceschini, A. Rossi, G. Golia, M. Zamboni, P. Tosoni, and P. Zardini Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2080 - 2085. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Vescovo, M Volterrani, R Zennaro, M Sandri, C Ceconi, R Lorusso, R Ferrari, G B Ambrosio, and L Dalla Libera Apoptosis in the skeletal muscle of patients with heart failure: investigation of clinical and biochemical changes Heart, October 1, 2000; 84(4): 431 - 437. [Abstract] [Full Text]
|
|
|
|
|
|
C Berry and A.L Clark Catabolism in chronic heart failure Eur. Heart J., April 1, 2000; 21(7): 521 - 532. [PDF]
|
|
|
|
|
|
V.G. Florea, M.Y. Henein, S.D. Anker, D.P. Francis, J.S. Chambers, P. Ponikowski, and A.J.S. Coats Prognostic value of changes over time in exercise capacity and echocardiographic measurements in patients with chronic heart failure Eur. Heart J., January 2, 2000; 21(2): 146 - 153. [Abstract] [PDF]
|
|
|
|
|
|
D.R. Murdoch and J.J.V. McMurray Cardiac cachexia--lean and mean Eur. Heart J., November 2, 1999; 20(22): 1609 - 1611. [PDF]
|
|
|
|
|
|
S. D. Anker and A. J. S. Coats Cardiac Cachexia: A Syndrome With Impaired Survival and Immune and Neuroendocrine Activation Chest, March 1, 1999; 115(3): 836 - 847. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Niebauer, C.-D. Pflaum, A. L. Clark, C. J. Strasburger, J. Hooper, P. A. Poole-Wilson, A. J. S. Coats, and S. D. Anker Deficient insulin-like growth factor I in chronic heart failure predicts altered body composition, anabolic deficiency, cytokine and neurohormonal activation J. Am. Coll. Cardiol., August 1, 1998; 32(2): 393 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P Wielenga, A. J S Coats, W. L Mosterd, and I. A Huisveld The role of exercise training in chronic heart failure Heart, November 1, 1997; 78(5): 431 - 436. [Full Text] [PDF]
|
|