Endothelial Function, Muscular Performance and Metabolism, and Physical Function in Patients with Chronic Heart Failure

• Main Authors: Cian-Ci Liou, 劉千綺
• Other Authors: Ying-Tai Wu
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/sqp2fb

碩士 === 國立臺灣大學 === 物理治療學研究所 === 99 === Background and Purpose: Shortness of breath, fatigue, and exercise intolerance are clinical symptoms of chronic heart failure (CHF). Recent studies suggested that peripheral impairment in neuroendocrine and vascular smooth muscle function was also related to their clinical symptoms. The increased peripheral resistance may influence limb blood flow, muscle fitness and activities of daily. The purposes of this study were to compare muscular strength, endurance, perfusion of quadriceps, endothelial function, and living status between CHF and coronary arterial disease (CAD) patients, as well as the healthy persons (HP), and the relations among the measured outcomes. Methods: Twenty-one male patients with stable CHF aged 62.0 ± 7.5 years were recruited from out-patient clinics at National Taiwan University Hospital. Patients were excluded if they have any other primary diseases that may affect the testing or the results. This study also recruited 29 subjects with CAD without heart failure (mean age: 59.9 ± 8.0 years) and 20 HP (mean age: 57.0 ± 7.5 years). Medical data, including medical history, left ventricular ejection fraction, NYHA functional classification, and medication, were retrieved from the chart review. Blood sample was collected to analyze endothelin-1 and high sensitivity C-reactive protein. All subjects took an isokinetic knee extension test at 60°s-1 (5 maximal contractions), 180°s-1 (5 maximal contractions), and 240°s-1 (30 maximal contractions) by Biodex isokinetic dynamometer, and the total work of 240°s-1 was used as indice of muscule endurance. Probes of NIRS were placed at the lowest 1/3 of right vastus lateralis (VL) and vastus medialis (VM) before and during the isokinetic testing. Subjects undertook the assessment of body composition, laser Doppler flowmetry combined iontophoresis, one minute sit-to-stand test, 6-minute walking test (6MWT), and filled in the questionnaire of 7-day recall physical activity questionnaire, Performance Measure for Activities of Daily Living-8 (PMADL-8), and Minnesota Living with Heart Failure Questionnaire (LHFQ). Group comparsions were made using one-way ANOVA or Kruskal-Wallis one-way ANOVA or chi-square test. The relationship among the relative change of Ach and SNP, resting and % change of HHb and saturation, muscle strength, endurance, one minute sit-to-stand test, 6MWT, and PDML-8 were analyzed by partial correlation coefficient, while age and physical activity were used as covariates. Results: The basic characteristics were similar among the three groups. Subjects in CHF group had higher CRP and lower physical activity, peak torque at 60°s-1 and 180°s-1, and also lower peak torque divided by body weight at 60°s-1 and 240°s-1 than CAD. Significantly lower SNP response, muscle strength and endurance, and sit-to-stand and 6MWT were noted in CHF than HP. CHF subjects had higher scores in PMADL-8 than HP and CAD and higher LHFQ scores than CAD, the lower values in PMADL-8 and LHFQ indicated better performance or quality. CHF had significantly longer recovery time in saturation (only VM) at 60°s-1, higher % change/work and longer recovery time of saturation (VL and VM) at 180°s-1 than HP. There was no significant difference in HHb or saturation at 240°s-1 for any between group comparsions. Relative change of Ach was positively correlated with peak torque at 180°s-1 and 240°s-1, total work of 240°s-1, and 6MWT. Relative change of SNP was significantly correlated with total work of 240°s-1. The baseline values of HHb in VL and VM were significantly correlated with PMADL-8. The baseline values of saturation in VL and VM were significantly correlated with peak torque, total work of 240°s-1, duration of 5 times sit-to-stand test, times of one minute sit-to-stand test, 6MWT, and PMADL-8, except 60°s-1 (VL and VM) and 180°s-1 (only VM) showed no significantly correlated with one minute sit-to-stand test. The % change of HHb in VL was only significantly correlated with peak torque, total work of 240°s-1, sit-to-stand test. The % change of HHb in VM was also significantly correlated with peak torque and PMADL-8. The relative change of Ach and SNP were not correlated significantly with HHb or saturation. Conclusion: Muscle strength, functional performance and quality of life were decreased in CHF compared with CAD. Oxygen saturation of quadriceps was decreased, and recovery time was prolonged in CHF. It suggested skeletal muscle metabolism was impaired in CHF; however, it was not consistent in different muscles or speed of contraction. Endothelial function indicated by Ach response, muscle HHb and O2 saturation had some correlations with their muscle and functional performance.