{"id":"8a638446cdd2","type":"article","url":"https://hartvaat.nl/2026/03/03/spierstofwisseling-bij-hfpef-verminderde-oxidatieve-capaciteit-los-van-ijzergebr/","title":"Spierstofwisseling bij HFpEF: verminderde oxidatieve capaciteit los van ijzergebrek (31P-MRS)","title_en":"Quantifying skeletal muscle energy metabolism during exercise in heart failure with preserved ejection fraction using in vivo 31P magnetic resonance spectroscopy","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","hfmref","hfpef","hfref","step-hfpef","vrouwen"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvaf035","source_url":"https://doi.org/10.1093/eschf/xvaf035","authors":["Jerremy Weerts","Suzanne N Voorrips","Jeroen A L Jeneson","Arantxa Barandiarán Aizpurua","Julian Mevenkamp","Anita J Sibeijn-Kuiper","Remco J Renken","Blanche L M Schroen","Christian Knackstedt","Alfons J H M Houben","Peter Van der Meer","Vera B Schrauwen-Hinderling","B Daan Westenbrink","Vanessa P M van Empel"],"significance":6,"published":"2026-03-03","source_date":"2026-03-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"Patients with heart failure and preserved ejection fraction (HFpEF) have markedly reduced exercise capacity with poorly understood, multifactorial causes. In this Dutch two-site study (58 HFpEF patients, 16 controls), in-vivo 31phosphorus MR spectroscopy measured mitochondrial oxidative muscle metabolism via phosphocreatine recovery after isometric or dynamic exercise. Phosphocreatine recovery halftime after isometric exercise was prolonged in HFpEF patients (27 vs 24 seconds), indicating reduced skeletal-muscle oxidative capacity. This held regardless of iron deficiency, whereas higher hs-CRP was associated with slower recovery. Exercise intolerance in HFpEF thus arises partly from intrinsically impaired muscle energetics, not iron deficiency alone.","created":"2026-07-03T10:32:19Z","updated":"2026-07-03T18:39:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Patiënten met hartfalen met behouden ejectiefractie (HFpEF) hebben een sterk verminderd inspanningsvermogen, met deels onbegrepen, multifactoriële oorzaken. In deze Nederlandse tweecentrastudie (58 HFpEF-patiënten en 16 controles) werd met in-vivo 31fosfor-MR-spectroscopie de mitochondriale oxidatieve spierstofwisseling gemeten via het herstel van fosfocreatine na isometrische of dynamische inspanning. De fosfocreatine-hersteltijd na isometrische inspanning was bij HFpEF-patiënten verlengd (27 vs. 24 seconden), wat wijst op een verminderde oxidatieve capaciteit van de skeletspier. Dit gold ongeacht ijzergebrek, terwijl een hoger hs-CRP wél met een trager herstel samenhing. De inspanningsintolerantie bij HFpEF komt dus mede voort uit een intrinsiek verminderde spierenergetica, niet uitsluitend uit ijzergebrek.","abstract_original":"BACKGROUND AND AIMS: Patients with heart failure and preserved ejection fraction (HFpEF) experience significant exercise intolerance, yet its underlying mechanisms remain poorly defined and are multifactorial. Iron deficiency (ID) occurs frequently in HFpEF and may contribute to exercise impairment. This study evaluated mitochondrial oxidative muscle metabolism in HFpEF using in vivo  31phosphorus magnetic resonance spectroscopy (31P-MRS) employing two exercise protocols, and assessed whether ID influences exercise energetics. METHODS: In this parallel analysis of prospective studies at two sites, patients with HFpEF and control individuals performed either isometric exercise (isolated leg protocol) or dynamic exercise (cardiopulmonary protocol) with concomitant phosphocreatine recovery assessment using in vivo  31P-MRS. Associations between clinical factors and oxidative metabolism were evaluated. ID was defined as ferritin <100 µg/L, or ferritin 100-299 µg/L with transferrin saturation <20%. RESULTS: Fifty-eight patients with HFpEF and 16 controls performed isometric exercise (n = 46 HFpEF; n = 16 control) or cardiopulmonary exercise (n = 12 HFpEF). Phosphocreatine recovery halftime after isometric exercise was prolonged in patients versus controls [27 (23-32) vs 24 (19-28) seconds, respectively; P = .03]. Phosphocreatine recovery halftime after dynamic exercise in patients was 39 (27-57) seconds. Both cohorts consisted of patients with and without ID (n = 19 and 27, and n = 6 and 6, respectively), who had comparable exercise and oxidative muscle capacity (all P > .42). High-sensitive C-reactive protein was associated with prolonged phosphocreatine recovery halftime (P =. 01). CONCLUSIONS: Patients with HFpEF exhibit impaired whole-muscle oxidative capacity of skeletal muscle, as shown by two different 31P-MRS protocols with upper leg measurements, independent of ID status. STUDY REGISTRATION: NTR6605, NTR7297 (https://onderzoekmetmensen.nl/nl/trial/55673); NCT05750940 (https://clinicaltrials.gov/study/NCT05750940)."}