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Exercise Intolerance in Chronic Heart Failure: The Role of Cortisol and the Catabolic State

  • Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)
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Abstract

Chronic heart failure (CHF) is a complex clinical syndrome leading to exercise intolerance due to muscular fatigue and dyspnea. Hemodynamics fail to explain the reduced exercise capacity, while a significant skeletal muscular pathology seems to constitute the main underlying mechanism for exercise intolerance in CHF patients. There have been proposed several metabolic, neurohormonal and immune system abnormalities leading to an anabolic/catabolic imbalance that plays a central role in the pathogenesis of the wasting process of skeletal muscle myopathy. The impairment of the anabolic axes is associated with the severity of symptoms and the poor outcome in CHF, whereas increased cortisol levels are predictive of exercise intolerance, ventilatory inefficiency and chronotropic incompetence, suggesting a significant contributing mechanism to the limited functional status. Exercise training and device therapy could have beneficial effects in preventing and treating muscle wasting in CHF. However, specific anabolic treatment needs more investigation to prove possible beneficial effects.

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Georgios Tzanis, Stavros Dimopoulos, Varvara Agapitou, and Serafim Nanas declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, “Evgenidio Hospital”, National & Kapodestrian University of Athens, Papadiamantopoulou str., 20, Athens, 11528, Greece

    Georgios Tzanis, Stavros Dimopoulos, Varvara Agapitou & Serafim Nanas

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  1. Georgios Tzanis
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  2. Stavros Dimopoulos
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  3. Varvara Agapitou
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  4. Serafim Nanas
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Correspondence to Stavros Dimopoulos.

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Tzanis, G., Dimopoulos, S., Agapitou, V. et al. Exercise Intolerance in Chronic Heart Failure: The Role of Cortisol and the Catabolic State. Curr Heart Fail Rep 11, 70–79 (2014). https://doi.org/10.1007/s11897-013-0177-1

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