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CLINICAL STUDY: HEART FAILURE

Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure

Mariantonietta Cicoira, MD^a, Luisa Zanolla, MD^a, Lorenzo Franceschini, MD^a, Andrea Rossi, MD^a, Giorgio Golia, MD^a, Mauro Zamboni, MD, Paolo Tosoni, MD and Piero Zardini, MD^a

^a Divisione Clinicizzata di Cardiologia, Università degli Studi di Verona, Verona, Italy
Clinica Geriatrica, Università degli Studi di Verona, Verona, Italy

Manuscript received December 1, 2000; revised manuscript received February 26, 2001, accepted March 22, 2001.

Reprint requests and correspondence: Dr. Mariantonietta Cicoira, Divisione Clinicizzata di Cardiologia, Ospedale Civile Maggiore, P.le Stefani, 1 37126 Verona, Italy
mariantonietta.cicoira{at}univr.it

OBJECTIVES

We sought to assess whether skeletal muscle mass might be a predictor of peak oxygen consumption (VO₂) and relation of the ventilation to carbon dioxide production (VE/VCO₂) slope in patients with chronic heart failure (CHF) independent of clinical conditions, neurohormonal activation and resting hemodynamics.

BACKGROUND

A variety of abnormalities characterize skeletal muscle and contribute to exercise intolerance in patients with CHF. Skeletal muscle mass is a determinant of peak VO₂ both in healthy patients and in patients with CHF, but there are no reports on the independent predictive value of this parameter, which can be measured with great accuracy by whole-body dual energy X-ray absorptiometry (DEXA). The influence of skeletal muscle mass on VE/VCO₂ slope is not known either.

METHODS

We prospectively evaluated 120 consecutive noncachectic patients with CHF. Every patient underwent a cardiopulmonary exercise test, an echo-Doppler examination and an evaluation of neurohormonal activation and body composition as assessed by DEXA.

RESULTS

At the univariate analysis, New York Heart Association (NYHA) class (p < 0.0001), age (p < 0.0001), male gender (p < 0.0001) and plasma renin (p < 0.0001) significantly related with peak VO₂. There was a significant correlation between lean mass and absolute peak VO₂ (r = 0.70, p < 0.0001) and VE/VCO₂ slope (r = –0.27; p < 0.01). At the multivariate analysis, lean mass predicted peak VO₂ and VE/VCO₂ slope independently of NYHA functional class, age, gender, neurohormonal activation and resting hemodynamics.

CONCLUSIONS

Skeletal muscle mass is an independent predictor of peak VO₂ and VE/VCO₂ slope in stable noncachectic patients with CHF. Future studies will determine whether an increase in skeletal muscle mass in the individual patient might result in an improvement in parameters of exercise capacity.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CHF = chronic heart failure   DEXA = dual energy X-ray absorptiometry   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   VCO2 = carbon dioxide production   VE = ventilation   VE/VCO2 = relation of the rate of ventilation to carbon dioxide production   VO2 = oxygen consumption

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