Skeletal Muscle Metabolism in Heart Failure

This chapter discusses the skeletal muscle metabolism in heart failure. A greater understanding of the mechanism underlying fatigue and reduced exercise tolerance has been gleaned from skeletal muscle metabolism studies in patients with heart failure using 31 P Magnetic Resonance Spectroscopy ( 31 P MRS). Further application of the technique in association with innovative physiological, biopsy, and molecular biological studies should further elucidate the mechanisms of symptoms for which the clinician, in the out-patients' department, often has little to offer. The discovery of changes in creatine phosphate (PCr) metabolism raises the possibility that creatine and PCr therapy may have a role in the future management of these patients. Whether these agents will be adequate on their own, or whether administration in combination with “facilitator” agents will be required is still unclear. However, the observation of biochemical abnormalities in vivo which are central to, or at least a marker of, inefficient muscle biochemistry metabolism presents a promising avenue of investigation approach and commence the next millennium.