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Loncar G, Garfias-Veitl T, Valentova M, Vatic M, Lainscak M, Obradović D, Dschietzig TB, Doehner W, Jankowska EA, Anker SD, von Haehling S. Bone status in men with heart failure: results from the Studies Investigating Co-morbidities Aggravating Heart Failure. Eur J Heart Fail 2023; 25:714-723. [PMID: 36781201 DOI: 10.1002/ejhf.2794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
AIM To assess bone status expressed as hip bone mineral density (BMD) in men with heart failure (HF). METHODS AND RESULTS A total of 141 male patients with HF underwent dual energy X-ray absorptiometry to assess their BMD. We analysed markers of bone metabolism. Patients were classified as lower versus higher BMD according to the median hip BMD (median = 1.162 g/cm2 ). Survival was assessed over 8 years of follow-up. Patients with lower BMD were older (71 ± 10 vs. 66 ± 9 years, p = 0.004), more likely to be sarcopenic (37% vs. 7%, p < 0.001) and to have lower peak oxygen consumption (absolute peak VO2 1373 ± 480 vs. 1676 ± 447 ml/min, p < 0.001), had higher osteoprotegerin and osteocalcin levels (both p < 0.05) compared to patients with higher BMD. Among 47 patients with repeated BMD assessments, a significant reduction in BMD was noted over 30 months of follow-up. In multivariate logistic regression analysis, serum osteocalcin remained independently related with lower BMD (odds ratio [OR] 1.738, 95% confidence interval [CI] 1.136-2.660, p = 0.011). Hip BMD and serum osteoprotegerin were independent predictors of impaired survival on Cox proportional hazard analysis (hazard ratio [HR] 0.069, 95% CI 0.011-0.444, p = 0.005, and HR 0.638, 95% CI 0.472-0.864, p = 0.004, respectively). CONCLUSIONS Patients with HF lose BMD over time. Markers of bone turnover can help in identifying patients at risk with osteocalcin being an independent marker of lower hip BMD and osteoprotegerin an independent predictor of death. HF patients with increased osteocalcin and osteoprotegerin may benefit from BMD assessment as manifest osteoporosis seems to be too late for clinically meaningful intervention in HF.
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Affiliation(s)
- Goran Loncar
- Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Goettingen, Germany
| | - Tania Garfias-Veitl
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Mirela Vatic
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Danilo Obradović
- Department of Cardiology/Internal Medicine, Heart Center Leipzig-University Leipzig, Leipzig, Germany
| | | | - Wolfram Doehner
- Berlin Institute of Health-Center for Regenerative Therapies (BCRT), Charité- Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité University Medical Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Ewa A Jankowska
- Department of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Stefan D Anker
- Berlin Institute of Health-Center for Regenerative Therapies (BCRT), Charité- Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (Virchow Klinikum), Charité University Medical Center Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
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Youn JC, Choi SW, Lee HS, Han S, Shin EC, Baek SH, Kang SMI. Prognostic Value of Leg Muscle Strength in Acute Heart Failure Syndrome. Med Sci Sports Exerc 2021; 53:19-25. [PMID: 32694371 DOI: 10.1249/mss.0000000000002432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Leg muscle strength (LMS) may be useful as a frailty index in patients with heart failure. However, LMS, until recently, has been indirectly estimated, and its prognostic value in acute heart failure syndrome (AHFS) is unclear. Therefore, we evaluated the prognostic value of direct LMS assessment and its relationship with proinflammatory mediators in patients with AHFS. METHODS We directly measured LMS at predischarge using a dynamometer in 110 prospectively and consecutively enrolled patients with AHFS (75 male; 60 ± 14 yr; mean ejection fraction, 29.9% ± 14.6%). The primary end point was cardiovascular (CV) events, defined as CV mortality, cardiac transplantation, or rehospitalization due to heart failure aggravation. Patients were divided into impaired and preserved LMS groups according to Contal and O'Quigley's method. RESULTS CV events occurred in 28 patients (25.5%) (including 5 CV deaths and 6 cardiac transplantations) during follow-up (median, 246 d; range = 11-888 d). Impaired LMS was associated with significantly higher levels of serum monokine induced by gamma interferon and poor clinical outcomes (P < 0.001). Multivariable Cox proportional hazard analysis (controlling for age, sex, body mass index, heart failure type, hemoglobin level, N-terminal pro-b-type natriuretic peptide level, and beta-blocker use) revealed LMS as an independent predictor of CV events (P = 0.017). CONCLUSION Impaired LMS, which might be used as a marker of frailty, is associated with increased levels of a proinflammatory chemokine and independently predicts clinical outcomes in patients with AHFS. The direct measurement of LMS is simple and feasible and might have important implications for the risk stratification of patients with AHFS.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, REPUBLIC OF KOREA
| | - Suk-Won Choi
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, REPUBLIC OF KOREA
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, REPUBLIC OF KOREA
| | - Seongwoo Han
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, REPUBLIC OF KOREA
| | - Eui-Cheol Shin
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, REPUBLIC OF KOREA
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, REPUBLIC OF KOREA
| | - Seok-MIn Kang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, REPUBLIC OF KOREA
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Katano S, Yano T, Tsukada T, Kouzu H, Honma S, Inoue T, Takamura Y, Nagaoka R, Ishigo T, Watanabe A, Ohori K, Koyama M, Nagano N, Fujito T, Nishikawa R, Takashima H, Hashimoto A, Katayose M, Miura T. Clinical Risk Factors and Prognostic Impact of Osteoporosis in Patients With Chronic Heart Failure. Circ J 2020; 84:2224-2234. [PMID: 33116003 DOI: 10.1253/circj.cj-20-0593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical significance of osteoporosis in chronic heart failure (CHF) remains unclear.Methods and Results:A total of 303 CHF patients (75 years, [interquartile range (IQR) 66-82 years]; 41% female) were retrospectively examined. Bone mineral densities (BMDs) at the lumbar spine, femoral neck, and total femur were measured by using dual-energy X-ray absorptiometry (DEXA), and osteoporosis was diagnosed when the BMD at any of the 3 sites was <70% of the Young Adult Mean percentage (%YAM). The prevalence of osteoporosis in CHF patients was 40%. Patients with osteoporosis were older (79 [IQR, 74-86] vs. 72 [IQR, 62-80] years), included a large percentage of females, had slower gait speed and had a lower body mass index. Multivariate logistic regression analysis indicated that sex, BMI, gait speed, loop diuretics use and no use of direct oral anticoagulants (DOACs) were independently associated with osteoporosis. Kaplan-Meier survival curves showed that the rate of death and heart failure hospitalization was higher in patients with osteoporotic BMD at 2 or 3 sites than in patients without osteoporosis (hazard ratio 3.45, P<0.01). In multivariate Cox regression analyses, osteoporotic BMD at 2 or 3 sites was an independent predictor of adverse events after adjustment for prognostic markers. CONCLUSIONS Loop diuretics use and no DOACs use are independently associated with osteoporosis in CHF patients. Osteoporosis is a novel predictor of worse outcome in patients with CHF.
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Affiliation(s)
- Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takanori Tsukada
- Cardiac Rehabilitation Center, Social Welfare Corporation, Hokkaido Social Work Association Obihiro Hospital
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Suguru Honma
- Department of Rehabilitation, Sapporo Cardiovascular Hospital
| | - Takuya Inoue
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Yuhei Takamura
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital
| | - Tomoyuki Ishigo
- Division of Hospital Pharmacy, Sapporo Medical University Hospital
| | - Ayako Watanabe
- Division of Nursing, Sapporo Medical University Hospital
| | - Katsuhiko Ohori
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Department of Cardiology, Hokkaido Cardiovascular Hospital
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.,Division of Health Care Administration and Management, Sapporo Medical University School of Medicine
| | - Masaki Katayose
- Department of Public Health, Sapporo Medical University School of Medicine.,Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
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Loncar G, Cvetinovic N, Lainscak M, Isaković A, von Haehling S. Bone in heart failure. J Cachexia Sarcopenia Muscle 2020; 11:381-393. [PMID: 32087616 PMCID: PMC7113538 DOI: 10.1002/jcsm.12516] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in osteoporosis and reduced bone mineral density affecting not only post-menopausal women but also men, particularly with coexisting chronic diseases. Bone status in patients with stable chronic heart failure (HF) has been rarely studied so far. HF and osteoporosis are highly prevalent aging-related syndromes that exact a huge impact on society. Both disorders are common causes of loss of function and independence, and of prolonged hospitalizations, presenting a heavy burden on the health care system. The most devastating complication of osteoporosis is hip fracture, which is associated with high mortality risk and among those who survive, leads to a loss of function and independence often necessitating admission to long-term care. Current HF guidelines do not suggest screening methods or patient education in terms of osteoporosis or osteoporotic fracture. This review may serve as a solid base to discuss the need for bone health evaluation in HF patients.
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Affiliation(s)
- Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, University Clinical Hospital Center 'Dr. Dragisa Misovic-Dedinje', Belgrade, Serbia
| | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg-August University, Goettingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
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