Endothelial Function, Muscular Performance and Metabolism, and Physical Function in Patients with Chronic Heart Failure
|Keywords:||慢性心衰竭;等速肌力測試;近紅外線光譜;內皮功能;生活功能;chronic heart failure;isokinetic test,;near-infrared spectroscopy;endothelial function;physical function||Issue Date:||2011||Abstract:||
方法：徵召21位平均年齡為62.0 ± 7.5歲男性慢性心臟衰竭患者（左心室射出率小於40%，診斷至少6個月且病情穩定3個月以上），另徵求29位平均年齡為59.9 ± 8.0歲無心衰竭之冠狀動脈疾病患者作為病人對照組，以及20位平均年齡57.0 ± 7.5歲且無心臟疾病診斷者作為健康對照組。排除條件為有骨骼肌肉系統疾病的臨床診斷，其他系統性的疾病可能會影響或不適合運動測試者。由病歷紀錄取得受試者病史、基本資訊、左心室射出率、紐約心臟學會分級及用藥情形，採集受試者血液分析內皮素-1與高敏感度C-反應蛋白。受試者接受身高、體重、身體組成和雷射都普勒血流測量儀合併離子電泳之測量，再用等速肌力儀讓受試者做三種不同角速度【慢速（60°s-1）、中速（180°s-1）和快速（240°s-1）】之最大膝伸直運動，以快速等速運動（膝蓋伸直30次）之總功評估受試者的肌耐力狀況。測試過程中同時利用近紅外線光譜偵測，計算肌肉中去氧血紅素（HHb）和組織氧飽合度（saturation）之改變量，近紅外線光譜的探頭位置為右股內、外側肌的下1/3處。受試者並接受一分鐘坐到站測試、六分鐘行走測驗，以及七日活動問卷、日常生活活動執行能力、明尼蘇達心衰竭生活狀態之問卷調查。以SPSS 13.0（SPSS Inc., Chicago, USA）進行統計分析，採用單因子變異數分析（one-way ANOVA）、無母數分析中克─瓦單因子等級變異數分析（Kruskal-Wallis one-way ANOVA by ranks）、或卡方檢定比較三組各參數之差異。並分析Ach和SNP相對改變量、肌肉灌流代謝基礎值、%改變量和半衰期時間、與肌力、肌耐力及生活功能之間的相關性，所有相關性分析皆使用淨相關分析（partial correlation），以年齡與身體活動量作為共變數。
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.
|Appears in Collections:||物理治療學系所|
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