Skeletal Muscle Abnormalities and Iron Deficiency in Chronic Heart FailureAn Exercise 31P Magnetic Resonance Spectroscopy Study of Calf Muscle

Vojtech Melenovsky, Katerina Hlavata, Petr Sedivy, Monika Dezortova, Barry A Borlaug, Jiri Petrak, Josef Kautzner, Milan Hajek

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

BACKGROUND: Heart failure (HF) is often associated with iron deficiency (ID). Skeletal muscle abnormalities are common in HF, but the potential role of ID in this phenomenon is unclear. In addition to hemopoiesis, iron is essential for muscle bioenergetics. We examined whether energetic abnormalities in skeletal muscle in HF are affected by ID and if they are responsive to intravenous iron.

METHODS AND RESULTS: Forty-four chronic HF subjects and 25 similar healthy volunteers underwent 31P magnetic resonance spectroscopy of calf muscle at rest and during exercise (plantar flexions). Results were compared between HF subjects with or without ID. In 13 ID-HF subjects, examinations were repeated 1 month after intravenous ferric carboxymaltose administration (1000 mg). As compared with controls, HF subjects displayed lower resting high-energy phosphate content, lower exercise pH, and slower postexercise PCr recovery. Compared with non-ID HF, ID-HF subjects had lower muscle strength, larger PCr depletion, and more profound intracellular acidosis with exercise, consistent with an earlier metabolic shift to anaerobic glycolysis. The exercise-induced PCr drop strongly correlated with pH change in HF group ( r=-0.71, P<0.001) but not in controls ( r=0.13, P=0.61, interaction: P<0.0001). Short-term iron administration corrected the iron deficit but had no effect on muscle bioenergetics assessed 1 month later.

CONCLUSIONS: HF patients display skeletal muscle myopathy that is more severe in those with iron deficiency. The presence of ID is associated with greater acidosis with exercise, which may explain early muscle fatigue. Further study is warranted to identify the strategy to restore iron content in skeletal muscle.

Original languageEnglish (US)
Pages (from-to)e004800
JournalCirculation. Heart failure
Volume11
Issue number9
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Fingerprint

Skeletal Muscle
Magnetic Resonance Spectroscopy
Iron
Exercise
Heart Failure
Muscles
Acidosis
Energy Metabolism
Muscle Fatigue
Muscle Strength
Glycolysis
Muscular Diseases
Healthy Volunteers
Phosphates

Keywords

  • heart failure
  • iron
  • magnetic resonance spectroscopy
  • metabolism
  • muscles

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Skeletal Muscle Abnormalities and Iron Deficiency in Chronic Heart FailureAn Exercise 31P Magnetic Resonance Spectroscopy Study of Calf Muscle . / Melenovsky, Vojtech; Hlavata, Katerina; Sedivy, Petr; Dezortova, Monika; Borlaug, Barry A; Petrak, Jiri; Kautzner, Josef; Hajek, Milan.

In: Circulation. Heart failure, Vol. 11, No. 9, 01.09.2018, p. e004800.

Research output: Contribution to journalArticle

Melenovsky, Vojtech ; Hlavata, Katerina ; Sedivy, Petr ; Dezortova, Monika ; Borlaug, Barry A ; Petrak, Jiri ; Kautzner, Josef ; Hajek, Milan. / Skeletal Muscle Abnormalities and Iron Deficiency in Chronic Heart FailureAn Exercise 31P Magnetic Resonance Spectroscopy Study of Calf Muscle In: Circulation. Heart failure. 2018 ; Vol. 11, No. 9. pp. e004800.
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T1 - Skeletal Muscle Abnormalities and Iron Deficiency in Chronic Heart FailureAn Exercise 31P Magnetic Resonance Spectroscopy Study of Calf Muscle

AU - Melenovsky, Vojtech

AU - Hlavata, Katerina

AU - Sedivy, Petr

AU - Dezortova, Monika

AU - Borlaug, Barry A

AU - Petrak, Jiri

AU - Kautzner, Josef

AU - Hajek, Milan

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N2 - BACKGROUND: Heart failure (HF) is often associated with iron deficiency (ID). Skeletal muscle abnormalities are common in HF, but the potential role of ID in this phenomenon is unclear. In addition to hemopoiesis, iron is essential for muscle bioenergetics. We examined whether energetic abnormalities in skeletal muscle in HF are affected by ID and if they are responsive to intravenous iron.METHODS AND RESULTS: Forty-four chronic HF subjects and 25 similar healthy volunteers underwent 31P magnetic resonance spectroscopy of calf muscle at rest and during exercise (plantar flexions). Results were compared between HF subjects with or without ID. In 13 ID-HF subjects, examinations were repeated 1 month after intravenous ferric carboxymaltose administration (1000 mg). As compared with controls, HF subjects displayed lower resting high-energy phosphate content, lower exercise pH, and slower postexercise PCr recovery. Compared with non-ID HF, ID-HF subjects had lower muscle strength, larger PCr depletion, and more profound intracellular acidosis with exercise, consistent with an earlier metabolic shift to anaerobic glycolysis. The exercise-induced PCr drop strongly correlated with pH change in HF group ( r=-0.71, P<0.001) but not in controls ( r=0.13, P=0.61, interaction: P<0.0001). Short-term iron administration corrected the iron deficit but had no effect on muscle bioenergetics assessed 1 month later.CONCLUSIONS: HF patients display skeletal muscle myopathy that is more severe in those with iron deficiency. The presence of ID is associated with greater acidosis with exercise, which may explain early muscle fatigue. Further study is warranted to identify the strategy to restore iron content in skeletal muscle.

AB - BACKGROUND: Heart failure (HF) is often associated with iron deficiency (ID). Skeletal muscle abnormalities are common in HF, but the potential role of ID in this phenomenon is unclear. In addition to hemopoiesis, iron is essential for muscle bioenergetics. We examined whether energetic abnormalities in skeletal muscle in HF are affected by ID and if they are responsive to intravenous iron.METHODS AND RESULTS: Forty-four chronic HF subjects and 25 similar healthy volunteers underwent 31P magnetic resonance spectroscopy of calf muscle at rest and during exercise (plantar flexions). Results were compared between HF subjects with or without ID. In 13 ID-HF subjects, examinations were repeated 1 month after intravenous ferric carboxymaltose administration (1000 mg). As compared with controls, HF subjects displayed lower resting high-energy phosphate content, lower exercise pH, and slower postexercise PCr recovery. Compared with non-ID HF, ID-HF subjects had lower muscle strength, larger PCr depletion, and more profound intracellular acidosis with exercise, consistent with an earlier metabolic shift to anaerobic glycolysis. The exercise-induced PCr drop strongly correlated with pH change in HF group ( r=-0.71, P<0.001) but not in controls ( r=0.13, P=0.61, interaction: P<0.0001). Short-term iron administration corrected the iron deficit but had no effect on muscle bioenergetics assessed 1 month later.CONCLUSIONS: HF patients display skeletal muscle myopathy that is more severe in those with iron deficiency. The presence of ID is associated with greater acidosis with exercise, which may explain early muscle fatigue. Further study is warranted to identify the strategy to restore iron content in skeletal muscle.

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KW - iron

KW - magnetic resonance spectroscopy

KW - metabolism

KW - muscles

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