Clinical problem In vivo skeletal muscle energetics during exercise - - PowerPoint PPT Presentation

4/21/2018 1

In vivo skeletal muscle energetics during exercise in pulmonary arterial hypertension

• JDL. Vos, BSc1 • MG. Haarman, MD1 • AJ. Sibeijn-Kuiper2 • RMF. Berger, MD, PhD1
• TP. Willems, MD, PhD3 • JAL. Jeneson, PhD2

1 Center for Congenital Heart Diseases, 1 Department of Pediatric Cardiology 2 NeuroImaging Center, Division of Neurosciences 3 Department of Radiology

University Medical Center Groningen

Clinical problem

University Medical Center Groningen

D'Alonzo, CHEST 1987

Scientific problem

University Medical Center Groningen

Pulmonary dysfunction Cardiac dysfunction Muscular dysfunction?

• Decreased muscle strength

(Pepplinkhuizen, submitted)

• Decreased microcirculation/vessels

(Potus, AJRCCM 2014)

• Fiber type shift I -> II

(Batt, AJRCMB 2014)

• Decreased mitochondrial density

and structure

(Pflieger, Circulation 2013)

Study Design (1)

University Medical Center Groningen

iPAH Control Population (n) 3 6 Age (y) median (range) 14,1 (13,1 – 18,0) 13,6 (10,5 – 18,0) Sex (f) 3 5 Height (cm) 155 – 169 150 – 177 Weight (kg) 37,0 – 70,0 35,0 – 62,0 BMI 15,2 – 24,5 15,6 – 20,8 WHO-FC I, II, III, IV 0,3,0,0 6,0,0,0

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Study Design (2)

Spirometry

• Lung capacity
• Max. ventilation

CPET

• Pulmonary efficiency
• Cardiac output & HR
• Exercise capacity

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Study Design (3)

In-vivo 31P-MR Spectroscopy of quadriceps muscle

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• Muscular energy reserve
• Muscular pH
• Recovery rate

In vivo 31P-MRS

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Energy reserve pH

In vivo 31P-MRS

University Medical Center Groningen

Video shown with permission of the person ìnvolved

Energy reserve pH

Recovery time

Brussels, Acad Radiol 2015

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Results (1) Spirometry

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reference normal

Results (2) CPET

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Results (3) in vivo muscle energetics

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end of exercise baseline

Results (3) post-exercise recovery

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Recovery time

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Conclusion (1)

University Medical Center Groningen

Pulmonary function Cardiac function Muscular function

High energy reserve Neutral pH values Normal recovery time University Medical Center Groningen

Dutch National Referral Center for Pediatric PH Center for Congenital Heart Diseases UMCG Rolf Berger, MD PhD Guido Bossers, MD Graziella Eshuis, BSc Diederik van der Feen, MD Marlies Haarman, MD Theresia Kazemier, MSc Annemarie Koop, MD Floris-Jan Ridderbos, MD Department of Neuroscience Jeroen Jeneson, PhD Anita Sibeijn-Kuiper Gert ter Horst, PhD Department of Radiology Tineke Willems, MD PhD

Thank you