Reduced Cardiorespiratory Fitness and Its Physiological Determinants in Patients With Cirrhosis: Evidence of Cirrhosis‐Induced Myopathy
Couret Alexis, Rannou Fabrice, Pereira Bruno, Marcantei Camille, Le Calvez François, Julian Valérie, Duclos Martine, Costes Frédéric, Muti Léon, Buchard Benjamin, Arbogast Sarah, King James A, Weil‐Verhoeven Delphine, Abergel Armand, Ennequin GaëlABSTRACT
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 (VO 2Peak ), ventilatory efficiency (VE/VCO 2 ), oxygen uptake efficiency slope (OUES), and chronotropic response. Non‐invasive hemodynamic monitoring (Physioflow) was used to estimate cardiac output and arteriovenous oxygen difference (a‐vO 2 ).
Results
Patients with cirrhosis exhibited markedly reduced CRF compared with controls (VO 2Peak : 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/VCO 2 , Wilkoff index) were also significantly impaired and chronotropic incompetence was highly prevalent (89%). Cardiac output was preserved but a‐vO 2 was lower (10.7 ± 3.0 vs. 14.1 ± 1.1 mlO 2 .dL −1 , p = 0.002), indicating a defective peripheral oxygen extraction in patients with cirrhosis. Multivariate regression analysis ( r 2 = 0.79) identified maximal heart rate and muscle performance (5‐sit to stand) as independent predictors of VO 2Peak .
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.