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European Journal of Heart Failure 2007 9(3):287-291; doi:10.1016/j.ejheart.2006.06.006
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© 2007 European Society of Cardiology

Chronic oral ascorbic acid therapy worsens skeletal muscle metabolism in patients with chronic heart failure

Angus K. Nightingalea,b,*, Jenifer G. Crilleyc, Nicholas C. Peggeb, Ernie A. Boehmc,d, Catherine Mumfordb, Doris J. Taylorc,d, Peter Stylesc,d, Kieran Clarkec and Michael P. Frenneauxb,e

a Bristol Heart Institute Bristol University, Bristol, UK
b Wales Heart Research Institute University of Wales College of Medicine, UK
c Department of Physiology, Anatomy and Genetics University of Oxford, UK
d MRC Biochemical and Clinical Magnetic Resonance Unit Oxford Radcliffe Hospital, Oxford, UK
e Department of Cardiovascular Medicine Birmingham University, UK

* Corresponding author. Department of Cardiology, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom. Tel.: +44 117 342 0492; fax: +44 117 342 0496. E-mail address: drangus{at}doctors.org.uk


  Abstract

Background: Chronic heart failure (CHF) is associated with abnormalities of skeletal muscle metabolism. This may be due to impaired oxygen delivery as a result of endothelial dysfunction.

Aims: We postulated that ascorbic acid would improve oxygen delivery to exercising muscle and improve skeletal muscle metabolism.

Methods: We studied skeletal muscle metabolism using 31P magnetic resonance spectroscopy in 39 CHF patients. Endothelial function was assessed by changes in pulse wave velocity. Subjects were randomised to receive 4g ascorbic acid daily for 4weeks in a placebo-controlled double-blind study.

Results: Ascorbic acid significantly increased phosphocreatine utilization during exercise. In addition, glycolytic ATP synthesis increased in the ascorbic acid group (change in rate of ATP synthesis at 1min –0.21±0.76 with placebo, 2.06±0.60 following ascorbic acid; p<0.05). Phosphocreatine and ADP recovery after exercise were not changed. The fall in pulse wave velocity during reactive hyperaemia was increased by ascorbic acid from –6.3±2.6% to –12.1±2.0% (p<0.05).

Conclusions: These findings suggest that ascorbic acid increased both phosphocreatine utilization and glycolytic ATP synthesis during exercise in patients with CHF implying worsened skeletal muscle metabolism despite improvements in endothelial function.

Key Words: Magnetic resonance spectroscopy • Ascorbic acid • Chronic heart failure • Endothelial function

Received November 23, 2005; Revised May 10, 2006; Accepted June 22, 2006


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