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von Haehling S, Ebner N, Dos Santos MR, Springer J, Anker SD. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol 2017; 14:323-341. [PMID: 28436486 DOI: 10.1038/nrcardio.2017.51] [Citation(s) in RCA: 215] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Body wasting is a serious complication that affects a large proportion of patients with heart failure. Muscle wasting, also known as sarcopenia, is the loss of muscle mass and strength, whereas cachexia describes loss of weight. After reaching guideline-recommended doses of heart failure therapies, the most promising approach to treating body wasting seems to be combined therapy that includes exercise, nutritional counselling, and drug treatment. Nutritional considerations include avoiding excessive salt and fluid intake, and replenishment of deficiencies in trace elements. Administration of omega-3 polyunsaturated fatty acids is beneficial in selected patients. High-calorific nutritional supplements can also be useful. The prescription of aerobic exercise training that provokes mild or moderate breathlessness has good scientific support. Drugs with potential benefit in the treatment of body wasting that have been tested in clinical studies in patients with heart failure include testosterone, ghrelin, recombinant human growth hormone, essential amino acids, and β2-adrenergic receptor agonists. In this Review, we summarize the pathophysiological mechanisms of muscle wasting and cachexia in heart failure, and highlight the potential treatment strategies. We aim to provide clinicians with the relevant information on body wasting to understand and treat these conditions in patients with heart failure.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Marcelo R Dos Santos
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Dr. Arnaldo Avenue, 455 Cerqueira César, 01246903 Sao Paulo, Brazil
| | - Jochen Springer
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Berlin-Brandenburg Centre for Regenerative Therapies, Charité Medical School, Augustenburger Platz 1, 13353 Berlin, Germany
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Saitoh M, Ishida J, Doehner W, von Haehling S, Anker MS, Coats AJS, Anker SD, Springer J. Sarcopenia, cachexia, and muscle performance in heart failure: Review update 2016. Int J Cardiol 2017; 238:5-11. [PMID: 28427849 DOI: 10.1016/j.ijcard.2017.03.155] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 02/06/2023]
Abstract
Cachexia in the context of heart failure (HF) has been termed cardiac cachexia, and represents a progressive involuntary weight loss. Cachexia is mainly the result of an imbalance in the homeostasis of muscle protein synthesis and degradation due to a lower activity of protein synthesis pathways and an over-activation of protein degradation. In addition, muscle wasting leads to of impaired functional capacity, even after adjusting for clinical relevant variables in patients with HF. However, there is no sufficient therapeutic strategy in muscle wasting in HF patients and very few studies in animal models. Exercise training represents a promising intervention that can prevent or even reverse the process of muscle wasting, and worsening the muscle function and performance in HF with muscle wasting and cachexia. The pathological mechanisms and effective therapeutic approach of cardiac cachexia remain uncertain, because of the difficulty to establish animal cardiac cachexia models, thus novel animal models are warranted. Furthermore, the use of improved animal models will lead to a better understanding of the pathways that modulate muscle wasting and therapeutics of muscle wasting of cardiac cachexia.
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Affiliation(s)
- Masakazu Saitoh
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Junichi Ishida
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | - Stephan von Haehling
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus S Anker
- Charité - Campus Benjamin Franklin (CBF), Department of Cardiology, Berlin, Germany Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | | | - Stefan D Anker
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Springer
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
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53
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von Haehling S, Papp Z, Anker SD. ESC Heart Failure: a new journal aims to broaden heart failure views. Eur J Heart Fail 2016; 18:1415-1419. [PMID: 27910285 DOI: 10.1002/ejhf.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Center Göttingen, Göttingen, Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Stefan D Anker
- Department of Cardiology and Pneumology, Innovative Clinical Trials, University Medical Center Göttingen, Göttingen, Germany
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54
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Okoshi MP, Capalbo RV, Romeiro FG, Okoshi K. Cardiac Cachexia: Perspectives for Prevention and Treatment. Arq Bras Cardiol 2016; 108:74-80. [PMID: 27812676 PMCID: PMC5245851 DOI: 10.5935/abc.20160142] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/23/2016] [Indexed: 12/27/2022] Open
Abstract
Cachexia is a prevalent pathological condition associated with chronic heart failure. Its occurrence predicts increased morbidity and mortality independent of important clinical variables such as age, ventricular function, or heart failure functional class. The clinical consequences of cachexia are dependent on both weight loss and systemic inflammation, which accompany cachexia development. Skeletal muscle wasting is an important component of cachexia; it often precedes cachexia development and predicts poor outcome in heart failure. Cachexia clinically affects several organs and systems. It is a multifactorial condition where underlying pathophysiological mechanisms are not completely understood making it difficult to develop specific prevention and treatment therapies. Preventive strategies have largely focused on muscle mass preservation. Different treatment options have been described, mostly in small clinical studies or experimental settings. These include nutritional support, neurohormonal blockade, reducing intestinal bacterial translocation, anemia and iron deficiency treatment, appetite stimulants, immunomodulatory agents, anabolic hormones, and physical exercise regimens. Currently, nonpharmacological therapy such as nutritional support and physical exercise are considered central to cachexia prevention and treatment.
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Affiliation(s)
- Marina Politi Okoshi
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP, Brazil
| | - Rafael Verardino Capalbo
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP, Brazil
| | - Fernando G Romeiro
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP, Brazil
| | - Katashi Okoshi
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, São Paulo, SP, Brazil
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55
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Konishi M, Ishida J, Saitoh M, Springer J. Clinical perspective for wasting in diaphragm, an ever-trained muscle. J Cachexia Sarcopenia Muscle 2016; 7:497-8. [PMID: 27625920 PMCID: PMC5011824 DOI: 10.1002/jcsm.12125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/29/2016] [Indexed: 01/07/2023] Open
Affiliation(s)
- Masaaki Konishi
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Junichi Ishida
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Masakazu Saitoh
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
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56
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57
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Angulo J, El Assar M, Rodríguez-Mañas L. Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults. Mol Aspects Med 2016; 50:1-32. [PMID: 27370407 DOI: 10.1016/j.mam.2016.06.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/18/2016] [Indexed: 12/13/2022]
Abstract
Frailty is a functional status that precedes disability and is characterized by decreased functional reserve and increased vulnerability. In addition to disability, the frailty phenotype predicts falls, institutionalization, hospitalization and mortality. Frailty is the consequence of the interaction between the aging process and some chronic diseases and conditions that compromise functional systems and finally produce sarcopenia. Many of the clinical manifestations of frailty are explained by sarcopenia which is closely related to poor physical performance. Reduced regenerative capacity, malperfusion, oxidative stress, mitochondrial dysfunction and inflammation compose the sarcopenic skeletal muscle alterations associated to the frailty phenotype. Inflammation appears as a common determinant for chronic diseases, sarcopenia and frailty. The strategies to prevent the frailty phenotype include an adequate amount of physical activity and exercise as well as pharmacological interventions such as myostatin inhibitors and specific androgen receptor modulators. Cell response to stress pathways such as Nrf2, sirtuins and klotho could be considered as future therapeutic interventions for the management of frailty phenotype and aging-related chronic diseases.
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Affiliation(s)
- Javier Angulo
- Unidad de Investigación Cardiovascular (IRYCIS/UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mariam El Assar
- Instituto de Investigación Sanitaria de Getafe, Getafe, Madrid, Spain
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58
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Loncar G, Springer J, Anker M, Doehner W, Lainscak M. Cardiac cachexia: hic et nunc. J Cachexia Sarcopenia Muscle 2016; 7:246-60. [PMID: 27386168 PMCID: PMC4929818 DOI: 10.1002/jcsm.12118] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
Cardiac cachexia (CC) is the clinical entity at the end of the chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely, the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. A better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia, and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.
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Affiliation(s)
- Goran Loncar
- Department of Cardiology Clinical Hospital Zvezdara Belgrade Serbia; School of Medicine University of Belgrade Belgrade Serbia
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Markus Anker
- Department of Cardiology Charité - Universitätsmedizin Berlin Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin Charité Universitätsmedizin Berlin Germany
| | - Mitja Lainscak
- Department of Cardiology and Department of Research and Education General Hospital Celje Celje Slovenia; Faculty of Medicine University of Ljubljana Ljubljana Slovenia
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59
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Scherbakov N, Doehner W. Searching for a relevant definition of sarcopenia: results from the cross-sectional EPIDOS study. J Cachexia Sarcopenia Muscle 2016; 7:100-1. [PMID: 27065221 PMCID: PMC4799861 DOI: 10.1002/jcsm.12090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nadja Scherbakov
- Center for Stroke Research CSB Charite University Medical School Berlin Germany; German Centre for Cardiovascular Research (DZHK) Berlin Germany
| | - Wolfram Doehner
- Center for Stroke Research CSB Charite University Medical School Berlin Germany; German Centre for Cardiovascular Research (DZHK) Berlin Germany; Department of Cardiology Charite University Medical School Berlin Germany
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60
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Jankowska EA, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, Banasiak W, Filippatos G, Anker SD, Ponikowski P. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail 2016; 18:786-95. [PMID: 26821594 DOI: 10.1002/ejhf.473] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/06/2015] [Accepted: 12/06/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS The aim of this study was to assess the net clinical and prognostic effects of intravenous (i.v.) iron therapy in patients with systolic heart failure (HF) and iron deficiency (ID). METHODS AND RESULTS We performed an aggregate data meta-analysis (random effects model) of randomized controlled trials that evaluated the effects of i.v. iron therapy in iron-deficient patients with systolic HF. We searched electronic databases up to September 2014. We identified five trials which fulfilled the inclusion criteria (509 patients received i.v. iron therapy in comparison with 342 controls). Intravenous iron therapy has been shown to reduce the risk of the combined endpoint of all-cause death or cardiovascular hospitalization [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.30-0.64, P < 0.0001], and the combined endpoint of cardiovascular death or hospitalization for worsening HF (OR 0.39, 95% CI 0.24-0.63, P = 0.0001). Intravenous iron therapy resulted in a reduction in NYHA class (data are reported as a mean net effect with 95% CIs for all continuous variables) (-0.54 class, 95% CI -0.87 to -0.21, P = 0.001); an increase in 6-min walking test distance (+31 m, 95% CI 18-43, P < 0.0001); and an improvement in quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ) score +5.5 points, 95% CI 2.8-8.3, P < 0.0001; European Quality of Life-5 Dimensions (EQ-5D) score +4.1 points, 95% CI 0.8-7.3, P = 0.01; Minnesota Living With Heart Failure Questionnaire (MLHFQ) score -19 points, 95% CI:-23 to -16, P < 0.0001; and Patient Global Assessment (PGA) +0.70 points, 95% CI 0.31-1.09, P = 0004]. CONCLUSION The evidence indicates that i.v. iron therapy in iron-deficient patients with systolic HF improves outcomes, exercise capacity, and quality of life, and alleviates HF symptoms.
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Affiliation(s)
- Ewa A Jankowska
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Michał Tkaczyszyn
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Tomasz Suchocki
- Biostatistics Group, Department of Genetics, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Marcin Drozd
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Stephan von Haehling
- Division of Innovative Clinical Trials, Department of Cardiology & Pulmonology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Wolfram Doehner
- Department of Cardiology, Virchow Klinikum, Charite - Universitätsmedizin, Berlin, Germany.,Center for Stroke Research Berlin, Charite - Universitätsmedizin, Berlin, Germany
| | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology & Pulmonology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Piotr Ponikowski
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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61
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Stugiewicz M, Tkaczyszyn M, Kasztura M, Banasiak W, Ponikowski P, Jankowska EA. The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications. Eur J Heart Fail 2016; 18:762-73. [PMID: 26800032 DOI: 10.1002/ejhf.467] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 12/26/2022] Open
Abstract
Skeletal and respiratory myopathy not only constitutes an important pathophysiological feature of heart failure and chronic obstructive pulmonary disease, but also contributes to debilitating symptomatology and predicts worse outcomes in these patients. Accumulated evidence from laboratory experiments, animal models, and interventional studies in sports medicine suggests that undisturbed systemic iron homeostasis significantly contributes to the effective functioning of skeletal muscles. In this review, we discuss the role of iron status for the functioning of skeletal muscle tissue, and highlight iron deficiency as an emerging therapeutic target in chronic diseases accompanied by a marked muscle dysfunction.
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Affiliation(s)
- Magdalena Stugiewicz
- Students' Scientific Association, Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Tkaczyszyn
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Monika Kasztura
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Banasiak
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa A Jankowska
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
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62
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Węgrzynowska-Teodorczyk K, Mozdzanowska D, Josiak K, Siennicka A, Nowakowska K, Banasiak W, Jankowska EA, Ponikowski P, Woźniewski M. Could the two-minute step test be an alternative to the six-minute walk test for patients with systolic heart failure? Eur J Prev Cardiol 2016; 23:1307-13. [PMID: 26743588 DOI: 10.1177/2047487315625235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The consequence of exercise intolerance for patients with heart failure is the difficulty climbing stairs. The two-minute step test is a test that reflects the activity of climbing stairs. DESIGN The aim of the study design is to evaluate the applicability of the two-minute step test in an assessment of exercise tolerance in patients with heart failure and the association between the six-minute walk test and the two-minute step test. METHODS Participants in this study were 168 men with systolic heart failure (New York Heart Association (NYHA) class I-IV). In the study we used the two-minute step test, the six-minute walk test, the cardiopulmonary exercise test and isometric dynamometer armchair. RESULTS Patients who performed more steps during the two-minute step test covered a longer distance during the six-minute walk test (r = 0.45). The quadriceps strength was correlated with the two-minute step test and the six-minute walk test (r = 0.61 and r = 0.48). The greater number of steps performed during the two-minute step test was associated with higher values of peak oxygen consumption (r = 0.33), ventilatory response to exercise slope (r = -0.17) and longer time of exercise during the cardiopulmonary exercise test (r = 0.34). Fatigue and leg fatigue were greater after the two-minute step test than the six-minute walk test whereas dyspnoea and blood pressure responses were similar. CONCLUSION The two-minute step test is well tolerated by patients with heart failure and may thus be considered as an alternative for the six-minute walk test.
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Affiliation(s)
- Kinga Węgrzynowska-Teodorczyk
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Poland Center for Heart Disease, 4th Military Academic Hospital Wroclaw, Poland
| | - Dagmara Mozdzanowska
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Poland
| | - Krystian Josiak
- Center for Heart Disease, 4th Military Academic Hospital Wroclaw, Poland Department of Heart Diseases, Wroclaw Medical University, Poland
| | - Agnieszka Siennicka
- Center for Heart Disease, 4th Military Academic Hospital Wroclaw, Poland Department of Physiology, Wroclaw Medical University, Poland
| | | | - Waldemar Banasiak
- Center for Heart Disease, 4th Military Academic Hospital Wroclaw, Poland
| | - Ewa A Jankowska
- Center for Heart Disease, 4th Military Academic Hospital Wroclaw, Poland Department of Heart Diseases, Wroclaw Medical University, Poland
| | - Piotr Ponikowski
- Center for Heart Disease, 4th Military Academic Hospital Wroclaw, Poland Department of Heart Diseases, Wroclaw Medical University, Poland
| | - Marek Woźniewski
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, Poland
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63
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Anker SD, von Haehling S, Germany R. Sleep-disordered breathing and cardiovascular disease. Indian Heart J 2015; 68 Suppl 1:S69-76. [PMID: 27056657 PMCID: PMC4824338 DOI: 10.1016/j.ihj.2015.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022] Open
Abstract
Sleep-disordered breathing (SDB) is a common comorbidity in a number of cardiovascular diseases, and mounting clinical evidence demonstrates that it has important implications in the long-term outcomes of patients with cardiovascular disease (CVD). While recognition among clinicians of the role of SDB in CVD is increasing, it too often remains neglected in the routine care of patients with CVD, and therefore remains widely undiagnosed and untreated. In this article, we provide an overview of SDB and its relationship to CVD, with the goal of helping cardiovascular clinicians better recognize and treat this important comorbidity in their patients. We will describe the two major types of SDB and discuss the pathophysiologic, diagnostic, and therapeutic considerations of SDB in patients with CVD.
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Affiliation(s)
- Stefan D Anker
- Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany.
| | - Stephan von Haehling
- Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
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64
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von Haehling S, Springer J. Treatment of Muscle Wasting: An Overview of Promising Treatment Targets. J Am Med Dir Assoc 2015; 16:1014-9. [DOI: 10.1016/j.jamda.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 12/27/2022]
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65
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Konishi M, Ishida J, Saito M, Springer J. Irisin - a myokine potentially bridging muscle and fat tissue in cachexia. J Cachexia Sarcopenia Muscle 2015; 6:396-7. [PMID: 26674742 PMCID: PMC4670751 DOI: 10.1002/jcsm.12085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/25/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | | | - Jochen Springer
- Institute of Innovative Clinical Trials ; Department of Cardiology and Pneumology, University Medical Centre Göttingen Göttingen, Germany
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66
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Cardiac cachexia: hic et nunc: "hic et nunc" - here and now. Int J Cardiol 2015; 201:e1-12. [PMID: 26545926 DOI: 10.1016/j.ijcard.2015.10.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023]
Abstract
Cardiac cachexia (CC) is the clinical entity at the end of chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. Better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick-up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.
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Doehner W, von Haehling S, Anker SD. Protective overweight in cardiovascular disease: moving from 'paradox' to 'paradigm'. Eur Heart J 2015; 36:2729-32. [PMID: 26341892 DOI: 10.1093/eurheartj/ehv414] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wolfram Doehner
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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Abstract
Sarcopenia (muscle wasting) and cachexia share some pathophysiological aspects. Sarcopenia affects approximately 20 %, cachexia <10 % of ambulatory patients with heart failure (HF). Whilst sarcopenia means loss of skeletal muscle mass and strength that predominantly affects postural rather than non-postural muscles, cachexia means loss of muscle and fat tissue that leads to weight loss. The wasting continuum in HF implies that skeletal muscle is lost earlier than fat tissue and may lead from sarcopenia to cachexia. Both tissues require conservation, and therapies that stop the wasting process have tremendous therapeutic appeal. The present paper reviews the pathophysiology of muscle and fat wasting in HF and discusses potential treatments, including exercise training, appetite stimulants, essential amino acids, growth hormone, testosterone, electrical muscle stimulation, ghrelin and its analogues, ghrelin receptor agonists and myostatin antibodies.
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Doehner W, Jankowska EA, Springer J, Lainscak M, Anker SD. Uric acid and xanthine oxidase in heart failure - Emerging data and therapeutic implications. Int J Cardiol 2015; 213:15-9. [PMID: 26318388 DOI: 10.1016/j.ijcard.2015.08.089] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/07/2015] [Indexed: 01/10/2023]
Abstract
The role of hyperuricaemia as cardiovascular risk factor has exhaustingly been debated for decades. While the association of elevated uric acid (UA) levels with increased mortality risk as convincingly been shown, the question whether UA is independently predictive of just a related effect within a more complex risk factor profile (including metabolic, inflammatory and haemodynamic risk factors) is still a matter of dispute. In heart failure the independent prognostic and functional impact of elevated UA has not only been shown but also the pathophysiologic mechanism(s) and the potential of targeted therapeutic interventions have been investigated in some detail. The emerging picture suggests the increased activity of the enzyme xanthine oxidase (XO) with corresponding increased production of free oxygen radical (ROS) as a main underlying principle with the resulting increase in UA levels being mostly a marker of this up-regulated pathway. While this concept will not diminish the value of UA as a prognostic marker, it provides the basis for a novel metabolic treatment option and the means to identify those patients most eligible for this tailored therapy. This review will summarize the recent evidence on XO as a novel and promising therapeutic target in heart failure.
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Affiliation(s)
- Wolfram Doehner
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany; Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Germany.
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Mitja Lainscak
- Division of Cardiology, University Clinic or Respiratory Diseases, Golnik, Slovenia
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
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