Comprehensive physiology · 2026
Reduced Cardiorespiratory Fitness and Its Physiological Determinants in Patients With Cirrhosis: Evidence of Cirrhosis-Induced Myopathy.
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Alexis Couret, Fabrice Rannou, Bruno Pereira, Camille Marcantei, François Le Calvez, Valérie Julian, Martine Duclos, Frédéric Costes, Léon Muti, Benjamin Buchard, Sarah Arbogast, A King James, Delphine Weil-Verhoeven, Armand Abergel, Gaël Ennequin
Аннотация
BACKGROUND: Cirrhosis induces multi-organ dysfunction, yet the specific physiological determinants underlying reduced cardiorespiratory fitness (CRF) remain poorly defined.
AIM: To compare patients with cirrhosis to healthy controls to assess and identify their major CRF physiological contributors.
METHODS: Forty-five patients with cirrhosis and 45 age- and sex-matched controls underwent incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. The pulmonary, cardiac, vascular, and muscular components of CRF were measured, including peak oxygen uptake (VO2Peak), ventilatory efficiency (VE/VCO2), oxygen uptake efficiency slope (OUES), and chronotropic response. Non-invasive hemodynamic monitoring (Physioflow) was used to estimate cardiac output and arteriovenous oxygen difference (a-vO2).
RESULTS: Patients with cirrhosis exhibited markedly reduced CRF compared with controls (VO2Peak: 15.4 ± 5.5 vs. 29.3 ± 7.5 mL.min-1.kg-1, p < 0.001) and the decline was proportional to Child-Pugh score. Kinetic parameters (OUES, Lowest VE/VCO2, Wilkoff index) were also significantly impaired and chronotropic incompetence was highly prevalent (89%). Cardiac output was preserved but a-vO2 was lower (10.7 ± 3.0 vs. 14.1 ± 1.1 mlO2.dL-1, p = 0.002), indicating a defective peripheral oxygen extraction in patients with cirrhosis. Multivariate regression analysis (r2 = 0.79) identified maximal heart rate and muscle performance (5-sit to stand) as independent predictors of VO2Peak.
CONCLUSION: Reduced CRF in cirrhosis appears to primarily result from impaired skeletal muscle oxygen utilization, compounded by chronotropic incompetence. These findings emphasize the value of integrative functional evaluation in cirrhosis management.
AIM: To compare patients with cirrhosis to healthy controls to assess and identify their major CRF physiological contributors.
METHODS: Forty-five patients with cirrhosis and 45 age- and sex-matched controls underwent incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. The pulmonary, cardiac, vascular, and muscular components of CRF were measured, including peak oxygen uptake (VO2Peak), ventilatory efficiency (VE/VCO2), oxygen uptake efficiency slope (OUES), and chronotropic response. Non-invasive hemodynamic monitoring (Physioflow) was used to estimate cardiac output and arteriovenous oxygen difference (a-vO2).
RESULTS: Patients with cirrhosis exhibited markedly reduced CRF compared with controls (VO2Peak: 15.4 ± 5.5 vs. 29.3 ± 7.5 mL.min-1.kg-1, p < 0.001) and the decline was proportional to Child-Pugh score. Kinetic parameters (OUES, Lowest VE/VCO2, Wilkoff index) were also significantly impaired and chronotropic incompetence was highly prevalent (89%). Cardiac output was preserved but a-vO2 was lower (10.7 ± 3.0 vs. 14.1 ± 1.1 mlO2.dL-1, p = 0.002), indicating a defective peripheral oxygen extraction in patients with cirrhosis. Multivariate regression analysis (r2 = 0.79) identified maximal heart rate and muscle performance (5-sit to stand) as independent predictors of VO2Peak.
CONCLUSION: Reduced CRF in cirrhosis appears to primarily result from impaired skeletal muscle oxygen utilization, compounded by chronotropic incompetence. These findings emphasize the value of integrative functional evaluation in cirrhosis management.