First Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, NKUA, Athens, Greece.
J Heart Lung Transplant. 2011 Dec;30(12):1403-8. doi: 10.1016/j.healun.2011.08.020. Epub 2011 Oct 7.
Several skeletal muscle abnormalities have been identified in patients with chronic heart failure (CHF), including endothelial dysfunction. We hypothesized that skeletal muscle microcirculation, assessed by near-infrared spectroscopy (NIRS), is impaired in CHF patients and is associated with disease severity.
Eighty-three stable patients with mild-moderate CHF (72 males, mean age 54 ± 14 years, body mass index 26.7 ± 3.4 kg/m(2)) and 8 healthy subjects, matched for age, gender and body mass index, underwent NIRS with the vascular occlusion technique and cardiopulmonary exercise testing (CPET) evaluation on the same day. Tissue oxygen saturation (StO(2), %), defined as the percentage of hemoglobin saturation in the microvasculature compartments, was measured in the thenar muscle by NIRS before, during and after 3-minute occlusion of the brachial artery. Measurements included StO(2), oxygen consumption rate (OCR, %/min) and reperfusion rate (RR, %/min). All subjects underwent a symptom-limited CPET on a cycle ergometer. Measurements included VO(2) at peak exercise (VO(2)peak, ml/kg/min) and anaerobic threshold (VO(2)AT, ml/kg/min), VE/VCO(2) slope, chronotropic reserve (CR, %) and heart rate recovery (HRR(1), bpm).
CHF patients had significantly lower StO(2) (75 ± 8.2 vs 80.3 ± 6, p < 0.05), lower OCR (32.3 ± 10.4 vs 37.7 ± 5.5, p < 0.05) and lower RR (10 ± 2.8 vs 15.7 ± 6.3, p < 0.05) compared with healthy controls. CHF patients with RR ≥9.5 had a significantly greater VO(2)peak (p < 0.001), VO(2)AT (p < 0.01), CR (p = 0.01) and HRR(1) (p = 0.01), and lower VE/VCO(2) slope (p = 0.001), compared to those with RR <9.5. In a multivariate analysis, RR was identified as an independent predictor of VO(2)peak, VE/VCO(2) slope and HRR(1).
Peripheral muscle microcirculation, as assessed by NIRS, is significantly impaired in CHF patients and is associated with disease severity.
几项骨骼肌异常已被确定在慢性心力衰竭（CHF）患者中，包括内皮功能障碍。我们假设，通过近红外光谱（NIRS）评估的骨骼肌微循环在 CHF 患者中受损，并且与疾病严重程度相关。
83 名稳定的轻度至中度 CHF 患者（72 名男性，平均年龄 54 ± 14 岁，体重指数 26.7 ± 3.4 kg/m²）和 8 名健康受试者，年龄、性别和体重指数匹配，在同一天接受 NIRS 和心肺运动测试（CPET）评估。通过 NIRS 在肱动脉闭塞 3 分钟前、期间和之后测量大鱼际肌肉中的组织氧饱和度（StO₂，%），定义为微血管腔中血红蛋白饱和度的百分比。测量包括 StO₂、耗氧量（OCR，%/min）和再灌注率（RR，%/min）。所有受试者在自行车测力计上进行了症状限制的 CPET。测量包括峰值运动时的 VO₂（VO₂峰值，ml/kg/min）和无氧阈值（VO₂AT，ml/kg/min）、VE/VCO₂斜率、变时储备（CR，%）和心率恢复（HRR（1），bpm）。
与健康对照组相比，CHF 患者的 StO₂（75 ± 8.2 对 80.3 ± 6，p < 0.05）、OCR（32.3 ± 10.4 对 37.7 ± 5.5，p < 0.05）和 RR（10 ± 2.8 对 15.7 ± 6.3，p < 0.05）均显著降低。RR≥9.5 的 CHF 患者的 VO₂峰值（p<0.001）、VO₂AT（p<0.01）、CR（p=0.01）和 HRR（1）（p=0.01）显著更高，VE/VCO₂斜率（p=0.001）显著更低与 RR<9.5 的患者相比。在多变量分析中，RR 被确定为 VO₂峰值、VE/VCO₂斜率和 HRR（1）的独立预测因子。
通过 NIRS 评估的外周肌肉微循环在 CHF 患者中明显受损，并且与疾病严重程度相关。
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