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Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure
Nuhr MJ, Pette D, Berger R, Quittan M, Crevenna R, Huelsman M, Wiesinger GF, Moser P, Fialka-Moser V, Pacher R
European Heart Journal 2004 Jan;25(2):136-143
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIMS: Patients with chronic heart failure (CHF) exhibit detrimental changes in skeletal muscle that contribute to their impaired physical performance. This study investigates the possibility of counteracting these changes by chronic low-frequency electrical stimulation (CLFS) of left and right thigh muscles. METHODS AND RESULTS: (mean +/- SD) 32 CHF patients (53 +/- 10 years) with an LVEF of 22 +/- 5%, NYHA II to IV, undergoing optimized drug therapy, were randomized in a CLFS group (CLFSG) or a control group (controls). The groups differed in terms of the intensity of stimulation, which elicited strong muscle contractions only in the CLFSG, whereas the controls received current input up to the sensory threshold without muscle contractions. Functional capacity was assessed by peak VO2, work capacity, and a 6-min-walk (6MW). Muscle biopsies were analyzed for myosin heavy chain (MHC) isoforms, citrate synthase (CS) and glyceraldehydephosphate dehydrogenase (GAPDH) activities. Peak VO2 (ml/min/kg) increased from 9.6 +/- 3.5 to 11.6 +/- 2.8 (p < 0.001) in the CLFSG, and decreased from 10.6 +/- 2.8 to 9.4 +/- 3.2 (p < 0.05) in the controls. The increase in the CLFSG was paralleled by increases in maximal workload (p < 0.05) and oxygen uptake at the anaerobic threshold (p < 0.01). The corresponding values of the controls were unchanged, as also the 6MW values, the MHC isoform distribution, and both CS and GAPDH activities. In the CLFSG, the 6-MW values increased (p < 0.001), CS activity was elevated (p < 0.05), GAPDH activity decreased (p < 0.01), and the MHC isoforms were shifted in the slow direction with increases in MHCI at the expense of MHCIId/x (p < 0.01). CONCLUSIONS: Our results suggest that CLFS is a suitable treatment to counteract detrimental changes in skeletal muscle and to increase exercise capacity in patients with severe CHF.
For more information on this journal, please visit http://www.harcourt-international.com/journals/EUHJ.

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