Gordon A, Hultman E, Kaijser L, Kristjansson S, Rolf C J, Nyquist O, Sylvén C
Department of Medicine, Karolinska Institute, Huddinge University Hospital, Sweden.
Cardiovasc Res. 1995 Sep;30(3):413-8.
Cardiac creatine levels are depressed in chronic heart failure. Oral supplementation of creatine to healthy volunteers has been shown to increase physical performance.
To evaluate the effects of creatine supplementation on ejection fraction, symptom-limited physical endurance and skeletal muscle strength in patients with chronic heart failure.
With a double-blind, placebo-controlled design 17 patients (age 43-70 years, ejection fraction < 40) were supplemented with creatine 20 g daily for 10 days. Before and on the last day of supplementation ejection fraction was determined by radionuclide angiography as was symptom-limited 1-legged knee extensor and 2-legged exercise performance on the cycle ergometer. Muscle strength as unilateral concentric knee extensor performance (peak torque, Nm at 180 degrees/s) was also evaluated. Skeletal muscle biopsies were taken for the determination of energy-rich phosphagens.
Ejection fraction at rest and at work did not change. Performance before creatine supplementation did not differ between placebo and creatine groups. While no change was seen in the placebo group compared to baseline, creatine supplementation increased skeletal muscle total creatine and creatine phosphate by 17 +/- 4% (P < 0.05) and 12 +/- 4% (P < 0.05), respectively. Increments were seen only in patients with < 140 mmol total creatine/kg d.w. (P < 0.05). One-legged performance (21%, P < 0.05), 2-legged performance (10%, P < 0.05), and peak torque, Nm (5%, P < 0.05) increased. Both peak torque and 1-legged performance increased linearly with increased skeletal muscle phosphocreatine (P < 0.05). The increments in 1-legged, 2-legged and peak torque were significant compared to the placebo group, (P < 0.05).
One week of creatine supplementation to patients with chronic heart failure did not increase ejection fraction but increased skeletal muscle energy-rich phosphagens and performance as regards both strength and endurance. This new therapeutic approach merits further attention.
慢性心力衰竭患者心脏肌酸水平降低。对健康志愿者口服补充肌酸已显示可提高身体机能。
评估补充肌酸对慢性心力衰竭患者射血分数、症状限制下的身体耐力和骨骼肌力量的影响。
采用双盲、安慰剂对照设计，17例患者（年龄43 - 70岁，射血分数<40）每天补充20 g肌酸，持续10天。在补充前和补充的最后一天，通过放射性核素血管造影测定射血分数，并在自行车测力计上测定症状限制下的单腿伸膝和双腿运动表现。还评估了作为单侧同心伸膝表现的肌肉力量（峰值扭矩，180度/秒时的牛顿米）。采集骨骼肌活检样本以测定富含能量的磷酸肌酸。
静息和运动时的射血分数未改变。安慰剂组和肌酸组补充肌酸前的表现无差异。与基线相比，安慰剂组未见变化，而补充肌酸使骨骼肌总肌酸和磷酸肌酸分别增加了17±4%（P<0.05）和12±4%（P<0.05）。仅在总肌酸<140 mmol/kg干重的患者中出现增加（P<0.05）。单腿表现（21%，P<0.05）、双腿表现（10%，P<0.05）和峰值扭矩，牛顿米（5%，P<0.05）增加。峰值扭矩和单腿表现均随骨骼肌磷酸肌酸增加呈线性增加（P<0.05）。与安慰剂组相比，单腿、双腿和峰值扭矩的增加具有显著性（P<0.05）。
对慢性心力衰竭患者补充一周肌酸并未增加射血分数，但增加了骨骼肌富含能量的磷酸肌酸以及力量和耐力方面的表现。这种新的治疗方法值得进一步关注。
