Adams Volker, Linke Axel, Winzer Ephraim
Clinic of Cardiology, Heart Center Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany.
Curr Heart Fail Rep. 2017 Dec;14(6):489-497. doi: 10.1007/s11897-017-0361-9.
Severe exercise intolerance and early fatigue are hallmarks of heart failure patients either with a reduced (HFrEF) or a still preserved (HFpEF) ejection fraction. This review, therefore, will provide a contemporary summary of the alterations currently known to occur in the skeletal muscles of both HFrEF and HFpEF, and provide some further directions that will be required if we want to improve our current understanding of this area.
Skeletal muscle alterations are well documented for over 20 years in HFrEF, and during the recent years also data are presented that in HFpEF muscular alterations are present. Alterations are ranging from a shift in fiber type and capillarization to an induction of atrophy and modulation of mitochondrial energy supply. In general, the molecular alterations are more severe in the skeletal muscle of HFrEF when compared to HFpEF. The alterations occurring in the skeletal muscle at the molecular level may contribute to exercise intolerance in HFrEF and HFpEF. Nevertheless, the knowledge of changes in the skeletal muscle of HFpEF is still sparsely available and more studies in this HF cohort are clearly warranted.
严重运动不耐受和早期疲劳是射血分数降低（HFrEF）或射血分数保留（HFpEF）的心力衰竭患者的特征。因此，本综述将对目前已知的HFrEF和HFpEF患者骨骼肌中发生的变化进行当代总结，并提供一些进一步的方向，如果我们想提高目前对该领域的理解，这些方向将是必需的。
骨骼肌改变在HFrEF中已有20多年的充分记录，近年来也有数据表明HFpEF中存在肌肉改变。改变范围从纤维类型和毛细血管化的转变到萎缩的诱导和线粒体能量供应的调节。一般来说，与HFpEF相比，HFrEF患者骨骼肌中的分子改变更为严重。骨骼肌在分子水平上发生的改变可能导致HFrEF和HFpEF患者的运动不耐受。然而，关于HFpEF患者骨骼肌变化的知识仍然很少，显然需要在这个心力衰竭队列中进行更多的研究。
