Skeletal muscle blood flow is reduced and O2 extraction is increased at rest in chronic heart failure (CHF). Knowledge of red blood cell (RBC) flow distribution within the capillary network is necessary for modeling O2 delivery and exchange in this disease. Intravital microscopy techniques were used to study the in vivo spinotrapezius muscle microcirculation in rats with CHF 7 wk after myocardial infarction and in sham-operated controls (sham). A decrease in mean muscle fiber width from 51.3 ± 1.9 μm in sham to 42.6 ± 1.4 μm in CHF rats ( P < 0.01) resulted in an increased lineal density of capillaries in CHF rats ( P < 0.05). CHF reduced ( P < 0.05) the percentage of capillaries supporting continuous RBC flow from 87 ± 5 to 66 ± 5%, such that the lineal density of capillaries supporting continuous RBC flow remained unchanged. The percentage of capillaries supporting intermittent RBC flow was increased in CHF rats (8 and 27% in sham and CHF, respectively, P < 0.01); however, these capillaries contributed only 2.3 and 3.3% of the total RBC flux in sham and CHF rats, respectively. In continuously RBC-perfused capillaries, RBC velocity (252 ± 20 and 144 ± 9 μm/s in sham and CHF, respectively, P < 0.001) and flux (21.4 ± 2.4 and 9.4 ± 1.1 cells/s in sham and CHF, respectively, P < 0.01) were markedly reduced in CHF compared with sham rats. Capillary “tube” hematocrit remained unchanged (0.22 ± 0.02 and 0.19 ± 0.02 in sham and CHF, respectively, P > 0.05). We conclude that CHF causes spinotrapezius fiber atrophy and reduces the number of capillaries supporting continuous RBC flow per fiber. Within these capillaries supporting continuous RBC flow, RBC velocity and flux are reduced 45–55%. This decreases the potential for O2 delivery but enhances fractional O2 extraction by elevating RBC capillary residence time. The unchanged capillary tube hematocrit suggests that any alterations in muscle O2 diffusing properties in CHF are mediated distal to the RBC.
Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure
