Detection of abnormal calf muscle metabolism in patients with heart failure using phosphorus-31 nuclear magnetic resonance

doi:10.1016/0002-9149(88)90266-4

The American Journal of Cardiology

Volume 62, Issue 17, 1 December 1988, Pages 1234-1240

https://doi.org/10.1016/0002-9149(88)90266-4 Get rights and content

Abstract

Patients with heart failure frequently report leg fatigue during exercise. At present, however, there is no objective method of detecting leg muscle abnormalities in such patients. To determine if phosphorus-31 nuclear magnetic resonance spectroscopy can provide such information, this technique was used to compare calf responses to stair climbing and plantarflexion in 20 patients with heart failure (peak oxygen consumption (VO₂) of 13.6 ± 5 ml/kg/min, ejection fraction 20 ± 5%) and 9 agematched normal subjects. Work was quantified by measuring VO₂. At rest, both groups exhibited similar inorganic phosphorus to phosphocreatine ( $P_{1} PCr$ ) ratios (patients with heart failure 0.21 ±0.07, normal subjects 0.21 ± 0.06, difference not significant) and pH levels (patients with heart failure 7.06 ± 0.17, normal subjects 7.05 ± 0.11, difference not significant). In both normal subjects and patients with heart failure, exercise resulted in a progressive rise in $P_{1} PCr$ as VO₂ increased. However, examination of the relation of VO₂ versus $P_{1} PCr$ revealed steeper slopes in patients with heart failure during both stair climbing and plantarflexion. Neither form of exercise decreased calf pH in normal subjects. In the patients with heart failure, significant decreases in pH were noted during the highest work level of plantarflexion (pH of heart failure patients 6.86 ± 0.20, pH of normal subjects 7.07 ± 0.14, p < 0.01). Metabolic recovery time was also prolonged in the patients with heart failure versus normal subjects (3.3 ± 0.8 vs 2.1 ± 0.5 minutes, respectively, p < 0.002). These findings indicate that phosphorus-31 nuclear magnetic resonance provides objective evidence of leg muscle abnormalities in patients with heart failure.

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Peak oxygen uptake ( $\dot{V}$ O₂peak) is a well-established prognostic marker in chronic heart failure (CHF). Cardiopulmonary exercise testing (CPET) provides physiological parameters other than $\dot{V}$ O₂peak that might have prognostic value. We aimed at determining whether exercise recovery data kinetics have prognostic implications over $\dot{V}$ O₂peak and Heart Failure Survival Score.
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$\dot{V}$ O₂-REC₂ was the strongest prognostic marker of death, heart transplantation, and mechanical heart implantation in severe CHF. This finding should be confirmed prospectively.
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Nous avons analysé les données à l’effort de 200 patients consécutifs souffrant d’ICC ayant été évalués pour une possible transplantation cardiaque et ayant subi une EECR à notre établissement entre 2004 et 2011. Nous avons calculé le taux de récupération de la consommation d’oxygène ( $\dot{V}$ O₂) 2 minutes après l’effort ( $\dot{V}$ O₂-REC₂) en utilisant la différence entre la $\dot{V}$ O₂ max et la $\dot{V}$ O₂ à la 2^e minute de récupération et l'avons exprimé en pourcentage du $\dot{V}$ O₂ max. L'issue primaire combinee était la durée entre de l'EECR au premier événement, parmi la mort, la transplantation cardiaque ou l’implantation d’un cœur mécanique.
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^☆: This study was supported in part by a grant-in-aid from the Southeastern Pennsylvania Chapter of the American Heart Association and by grant RO-1 HL34834 and Research Career Development Award HL01766 to Dr. Wilson from the National Institutes of Health, Bethesda, Maryland.

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Detection of abnormal calf muscle metabolism in patients with heart failure using phosphorus-31 nuclear magnetic resonance☆

Abstract

J Biol Chem

Am J Cardiol

Int J Cardiol

Mitochondrial regulation of phosphocreatine/inorganic phosphate ratios in exercising human muscle: a gated 31P NMR study

Noninvasive, nondestructive approaches to cell bioenergetics

Mitochondrial regulation of phosphocreatine/inorganic phosphate ratios in exercising human muscle: a gated ³¹P NMR study