Catabolism in chronic heart failure.
نویسندگان
چکیده
Why can chronic heart failure be a catabolic state? The resting metabolic rate of some, but not all patients with heart failure is increased. Resting metabolic rate may account for up to 70% of daily energy expenditure in heart failure, and increases with NYHA functional class. Resting energy expenditure accounts for a greater proportion of daily energy expenditure in heart failure patients, although there may be no difference in absolute resting energy expenditure, when compared with healthy controls. Paradoxically, average daily energy expenditure in heart failure patients falls with increased severity of disease. These facts may be explained through greater energy conservation, as a result of a reduction in physical activity rather than energy loss through an increase in resting metabolic rate. Factors which contribute to an increased resting metabolic rate in heart failure may be increased cardiac and ventilatory work, and increased resting peripheral oxygen consumption. Oxidative lipid metabolism is activated in heart failure and free fatty acid levels are reported to be higher in heart failure than normal. In these patients, left ventricular ejection fraction is inversely correlated with rates of free fatty acid oxidation, whereas plasma norepinephrine and growth hormone are positively related to free fatty acid oxidation rates. Increased norepinephrine stimulates hormone-sensitive lipase which results in increased lipolysis and loss of body fat stores. Loss of muscle bulk happens early in the course of chronic heart failure, as a consequence of both the disease process and physical inactivity. Reduced bone mass is common in heart failure and is related to low levels of serum vitamin D and secondary hyperparathyroidism. Ultimately, cardiac cachexia
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ورودعنوان ژورنال:
- European heart journal
دوره 21 7 شماره
صفحات -
تاریخ انتشار 2000