Original clinical scienceSkeletal muscle microcirculatory abnormalities are associated with exercise intolerance, ventilatory inefficiency, and impaired autonomic control in heart failure
Section snippets
Study population
The study group consisted of 83 patents with stable CHF (72 males; mean age 54 ± 14 years, body mass index 26.7 ± 3.4 kg/m2) with a left ventricular ejection fraction (LVEF) ≤45%. All patients were on a stable optimal medical regimen for at least 3 months. They were referred to our laboratory from the heart failure clinic of our institution to perform a symptom-limited cardiopulmonary exercise test (CPET), as part of heart failure evaluation. Exclusion criteria from the study were moderate to
Results
All subjects completed the exercise protocol and none complained of unbearable pain or discomfort during the arm circulatory occlusion. HR recovery could not be calculated with accuracy in 6 CHF patients due to consistent artifacts from the signal of electrodes during recovery period. Similarly, VO2/t-slope could not be calculated in 3 patients as they removed the low-resistance valve due to discomfort during the recovery period.
No statistical differences were noted regarding age, gender and
Discussion
In this study we have demonstrated that: (1) patients with CHF present several skeletal muscle tissue microcirculation abnormalities as assessed by the near-infrared spectroscopy vascular occlusion technique; and (2) peripheral microcirculation alterations are associated with disease severity as expressed by exercise intolerance, ventilatory inefficiency and autonomic nervous system abnormalities in CHF patients. To our knowledge, this is the first study to evaluate peripheral microcirculation
Clinical implications
The NIRS occlusion technique through reperfusion rate measurement, an indirect indication of endothelial function, may be used to evaluate CHF severity. This technique is a relatively new approach that has been applied in healthy subjects,6 smokers,7 critically ill patients9 and CHF patients.8, 15, 17 This simple, bedside, non-invasive method could also be used as a monitoring and prognostic tool in patients unable to undergo CPET for evaluation of functional status. Future studies are needed
Study limitations
The results of our study should be applied mainly to male CHF patients. Although we did not directly evaluate endothelial function, the NIRS occlusion technique was applied as an indirect evaluation of peripheral tissue microcirculation.6, 7, 8, 9, 15, 17 Thus, the effects of central factors, such as reduced cardiac output or oxygen delivery, cannot be addressed easily by NIRS, requiring the use of invasive methodology—yet this was beyond the scope our study. Although there were no artifact
Disclosure statement
None of the authors have any conflicts of interest to disclose. This work was supported by a grant from the special account for research grants of the National and Kapodistrian University of Athens, Athens, Greece.
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