Functional and morphological skeletal muscle abnormalities correlate with reduced electromyographic activity in chronic heart failure.
BACKGROUND
Exercise intolerance and early muscle fatigue are key symptoms in patients with chronic heart failure (CHF). In advanced stages of the disease, profound metabolic abnormalities have been described finally leading to a catabolic state with progressive loss of muscle bulk. The aim of this study was to investigate morphological, functional and electromyographical parameters of the skeletal muscle in CHF.


METHODS
We included 17 patients with CHF and 12 age-matched healthy controls (left ventricular ejection fraction 25+/-2 versus 68+/-1%, body mass index 26.6+/-0.8 versus 28.0+/-1.0 kg/m2; P=NS) in this study. Cross-sectional area (CSA) of the thigh was assessed by computed tomography. Under electromyographical control, maximal and submaximal (30%) isometric strength as well as the relative decrease of muscle strength of the quadriceps muscle over a period of 20 s were determined.


RESULTS
Patients with CHF showed a significant reduction of muscle CSA (134.8+/-5.3 versus 165.2+/-7.4 cm2, P=0.002) as compared with healthy controls. The maximal quadriceps muscle strength was found to be significantly reduced in patients with CHF (226.7+/-22.3 versus 286.9+/-17.1 N, P<0.05) who also exhibited a higher extent of muscular fatigability (-2.18+/-0.33 versus -0.54+/-0.20 N/s, P<0.01). Electromyographic activity at 30% submaximal contraction showed a lower increase in patients with CHF (66+/-22 versus 114+/-36%; P<0.05) indicating impaired muscle fibre recruitment. Furthermore, a significant correlation between muscular fatigability and reduced electromyographic activity was found in CHF (r=0.84; P<0.001).


CONCLUSIONS
Our findings demonstrate an impaired electromyographic activity and muscular function in patients with CHF suggesting a new pathomechanism contributing to functional abnormalities of the skeletal muscle in advanced stages of this disease.
Schulze
P Christian
PC
University of Leipzig, Heart Center, Department of Cardiology, Strümpellstrasse 39, 04289 Leipzig, Germany. pcschulze@rics.bwh.harvard.edu
Linke
Axel
A
Schoene
Nina
N
Winkler
Sven Möbius
SM
Adams
Volker
V
Conradi
Stefan
S
Busse
Martin
M
Schuler
Gerhard
G
Hambrecht
Rainer
R
D016022:Case-Control Studies; D004576:Electromyography; D005080:Exercise Test; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D008297:Male; D008875:Middle Aged; D018763:Muscle Fatigue / Q000502:physiology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D011859:Radiography; D013848:Thigh; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D014409:Tumor Necrosis Factor-alpha