Victor M Niemeijer1, Tim Snijders2, Lex B Verdijk3, Janneau van Kranenburg4, Bart B L Groen5, Andrew M Holwerda6, Ruud F Spee7, Pieter F F Wijn8, Luc J C van Loon9, Hareld M C Kemps10. 1. Department of Cardiology, Máxima Medical Centre, Veldhoven, the Netherlands, Netherlands. 2. Human Movement Sciences, Maastricht University Medical Centre+, Netherlands. 3. Human Movement Sciences, Maastricht University Medical Centre, Netherlands. 4. Human Movement Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+ (MUMC+). 5. Department of Human Movement Sciences, Maastricht University Medical Centre, Netherlands. 6. Human Biology, Maastricht University Medical Centre, Netherlands. 7. Department of Cardiology, Maxima Medical Center, Netherlands. 8. Department of Applied Physics, Eindhoven University of Technology. 9. NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Netherlands. 10. Cardiology, Máxima Medical Centre, Netherlands.
Abstract
INTRODUCTION: Skeletal muscle function in patients with heart failure and reduced ejection fraction (HFrEF) greatly determines exercise capacity. However, reports on skeletal muscle fiber dimensions, fiber capillarization, and their physiological importance are inconsistent. METHODS: Twenty-five moderately-impaired patients with HFrEF and 25 healthy control (HC) subjects underwent muscle biopsy sampling. Type I and type II muscle fiber characteristics were determined by immunohistochemistry. In patients with HFrEF, enzymatic oxidative capacity was assessed, and pulmonary oxygen uptake (VO2) and skeletal muscle oxygenation during maximal and moderate-intensity exercise were measured using near-infrared spectroscopy. RESULTS: While muscle fiber cross-sectional area (CSA) was not different between patients with HFrEF and HC, percentage of type I fibers was higher in HC (46±15% versus 37±12%, respectively, P=0.041). Fiber type distribution and CSA were not different between patients in New York Heart Association (NYHA) class II and III. Type I muscle fiber capillarization was higher in HFrEF compared with controls (capillary-to-fiber perimeter exchange (CFPE) index: 5.70±0.92 versus 5.05±0.82, respectively, P=0.027). Patients in NYHA class III had slower VO2 and muscle deoxygenation kinetics during onset of exercise, and lower muscle oxidative capacity than those in class II (P<0.05). Also, fiber capillarization was lower, but not compared with HC. Higher CFPE index was related to faster deoxygenation (rspearman=-0.682, P=0.001), however, not to muscle oxidative capacity (r=-0.282, P=0.216). CONCLUSIONS: Type I muscle fiber capillarization is higher in HFrEF compared with HC, but not in patients with greater exercise impairment. Greater capillarization may positively affect VO2 kinetics by enhancing muscle oxygen diffusion.
INTRODUCTION: Skeletal muscle function in patients with heart failure and reduced ejection fraction (HFrEF) greatly determines exercise capacity. However, reports on skeletal muscle fiber dimensions, fiber capillarization, and their physiological importance are inconsistent. METHODS: Twenty-five moderately-impaired patients with HFrEF and 25 healthy control (HC) subjects underwent muscle biopsy sampling. Type I and type II muscle fiber characteristics were determined by immunohistochemistry. In patients with HFrEF, enzymatic oxidative capacity was assessed, and pulmonary oxygen uptake (VO2) and skeletal muscle oxygenation during maximal and moderate-intensity exercise were measured using near-infrared spectroscopy. RESULTS: While muscle fiber cross-sectional area (CSA) was not different between patients with HFrEF and HC, percentage of type I fibers was higher in HC (46±15% versus 37±12%, respectively, P=0.041). Fiber type distribution and CSA were not different between patients in New York Heart Association (NYHA) class II and III. Type I muscle fiber capillarization was higher in HFrEF compared with controls (capillary-to-fiber perimeter exchange (CFPE) index: 5.70±0.92 versus 5.05±0.82, respectively, P=0.027). Patients in NYHA class III had slower VO2 and muscle deoxygenation kinetics during onset of exercise, and lower muscle oxidative capacity than those in class II (P<0.05). Also, fiber capillarization was lower, but not compared with HC. Higher CFPE index was related to faster deoxygenation (rspearman=-0.682, P=0.001), however, not to muscle oxidative capacity (r=-0.282, P=0.216). CONCLUSIONS: Type I muscle fiber capillarization is higher in HFrEF compared with HC, but not in patients with greater exercise impairment. Greater capillarization may positively affect VO2 kinetics by enhancing muscle oxygen diffusion.