Patients with severe heart failure exhibit a blunted ammonia response but an exaggerated lactate response to exercise when normalized for work rate, suggesting impaired purine degradation via the AMP-to-IMP pathway in skeletal muscle.
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Hypothesis-generating for skeletal muscle purine defects in heart failure; should not change clinical exercise assessment without prospective validation.
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Kinugawa et al. (1999) studied this question.
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