1
|
Hindi J, Fréchette-Le Bel M, Rouleau JL, de Denus S. Influence of Weight and Body Size on the Pharmacokinetics of Heart Failure Pharmacotherapy: A Systematic Review. Ann Pharmacother 2024; 58:255-272. [PMID: 37338205 DOI: 10.1177/10600280231179484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To conduct a review of studies evaluating the influence of body size and weight (WT) on the pharmacokinetics (PK) of drugs recommended for heart failure (HF) treatment. DATA SOURCES A systematic search of the MEDLINE (1946 to April 2023) and EMBASE (1974 to April 2023) databases was conducted for articles that focused on the impact of WT or body size on the PK of drugs of interest used in HF patients. STUDY SELECTION AND DATA EXTRACTION Articles written in English or French related to the aim of our study were retained for analysis. DATA SYNTHESIS Of 6493 articles, 20 were retained for analysis. Weight was associated with the clearance of digoxin, carvedilol, enalapril, and candesartan as well as the volume of distribution of eplerenone and bisoprolol. There was no documented direct impact of WT on the PK of furosemide, valsartan, and metoprolol, although these studies were limited or confounded by the small sample size, adjustment of PK factors by WT, or the use of the Cockroff-Gault equation for the evaluation of creatinine clearance, which includes WT. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review highlights and summarizes the available data on the importance of WT on the PK of HF treatment. CONCLUSION Considering the significant impact of WT on most HF drugs in this review, it may be important to further investigate it in the context of personalized therapy, particularly in patients presenting extreme WTs.
Collapse
Affiliation(s)
- Jessica Hindi
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
- Beaulieu-Saucier Pharmacogenomics Center, Université de Montréal, Montreal, QC, Canada
| | | | - Jean Lucien Rouleau
- Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
- Beaulieu-Saucier Pharmacogenomics Center, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
2
|
Ikoma T, Narumi T, Akita K, Sato R, Masuda T, Kaneko H, Toda M, Mogi S, Sano M, Suwa K, Naruse Y, Ohtani H, Saotome M, Maekawa Y. Association of an Increased Abnormal Mitochondria Ratio in Cardiomyocytes with a Prolonged Oxygen Uptake Time Constant during Cardiopulmonary Exercise Testing of Patients with Non-ischemic Cardiomyopathy. Intern Med 2023; 62:2163-2170. [PMID: 36450468 PMCID: PMC10465282 DOI: 10.2169/internalmedicine.0697-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The cardiac function, blood distribution, and oxygen extraction in the muscles as well as the pulmonary function determine the oxygen uptake (VO2) kinetics at the onset of exercise. This factor is called the VO2 time constant, and its prolongation is associated with an unfavorable prognosis for heart failure (HF). The mitochondrial function of skeletal muscle is known to reflect exercise tolerance. Morphological changes and dysfunction in cardiac mitochondria are closely related to HF severity and its prognosis. Although mitochondria play an important role in generating energy in cardiomyocytes, the relationship between cardiac mitochondria and the VO2 time constant has not been elucidated. Methods We calculated the ratio of abnormal cardiac mitochondria in human myocardial biopsy samples using an electron microscope and measured the VO2 time constant during cardiopulmonary exercise testing. The VO2 time constant was normalized by the fat-free mass index (FFMI). Patients Fifteen patients with non-ischemic cardiomyopathy (NICM) were included. Patients were divided into two groups according to their median VO2 time constant/FFMI value. Results Patients with a low VO2 time constant/FFMI value had a lower abnormal mitochondria ratio than those with a high VO2 time constant/FFMI value. A multiple linear regression analysis revealed that the ratio of abnormal cardiac mitochondria was independently associated with a high VO2 time constant/FFMI. Conclusion An increased abnormal cardiac mitochondria ratio might be associated with a high VO2 time constant/FFMI value in patients with NICM.
Collapse
Affiliation(s)
- Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Taro Narumi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Keitaro Akita
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Ryota Sato
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Takayuki Masuda
- Department of Rehabilitation, Hamamatsu University Hospital, Japan
| | - Hanami Kaneko
- Department of Rehabilitation, Hamamatsu University Hospital, Japan
| | - Masahiro Toda
- Department of Rehabilitation, Hamamatsu University Hospital, Japan
| | - Satoshi Mogi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
| |
Collapse
|
3
|
Seko Y, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Shiba M, Yamamoto E, Yoshikawa Y, Kitai T, Yamashita Y, Iguchi M, Nagao K, Kawase Y, Morinaga T, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Weight loss during follow-up in patients with acute heart failure: From the KCHF registry. PLoS One 2023; 18:e0287637. [PMID: 37352293 PMCID: PMC10289349 DOI: 10.1371/journal.pone.0287637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/11/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUNDS The prognostic implication of weight loss after discharge from acute heart failure (AHF) remains unclear. We sought to investigate the association of weight loss between discharge and 6-month visit with subsequent clinical outcomes in patients with AHF. METHODS We analyzed 686 patients with AHF in the prospective longitudinal follow-up study derived from the Kyoto Congestive Heart Failure registry, and divided them into 2 groups based on the weight loss at 6-month index visit. We defined the weight loss as ≥ 5% decrease in body weight from discharge to 6-month index visit. RESULTS There were 90 patients (13.1%) with a weight loss at 6-month visit. Patients in the weight loss group compared with those in the no weight loss group had higher body weight at discharge and lower body weight at 6-mont visit. Patients in the weight loss group had a lower systolic blood pressure, higher brain-type natriuretic peptide, lower serum albumin, lower hemoglobin, higher prevalence of heart failure with reduced ejection fraction at 6-month visit, and a lower prescription rate of inhibitors of renin-angiotensin system than those in the no weight loss group. The cumulative 6-month incidence of all-cause death was significantly higher in the weight loss group than in the no weight loss group (14.2% and 4.3%, log-rank P<0.001). The excess adjusted risk of the weight loss group relative to the no weight loss group remained significant for all-cause death (HR 2.39, 95%CI 1.01-5.65, P = 0.048). CONCLUSION Body weight loss of ≥5% at 6-month visit after discharge was associated with subsequent all-cause death in patients with AHF.
Collapse
Affiliation(s)
- Yuta Seko
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasutaka Inuzuka
- Cardiovascular Medicine, Shiga General Hospital, Moriyama, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Tenri, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
4
|
Driggin E, Chung A, Concha D, Stanton L, Topkara VK, Maurer MS, Fried JA, Latif F, Takeda K, Sayer G, Uriel N, Clerkin KJ. The impact of pre-transplant weight loss on survival following cardiac transplantation. Clin Transplant 2022; 36:e14831. [PMID: 36271917 PMCID: PMC9984247 DOI: 10.1111/ctr.14831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/07/2022] [Accepted: 09/24/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Significant weight loss due to cardiac cachexia is an independent predictor of mortality in many heart failure (HF) clinical trials. The impact of significant weight loss while on the waitlist for heart transplant (HT) has yet to be studied with respect to post-transplant survival. METHODS Adult HT recipients from 2010 to 2021 were identified in the UNOS registry. Patients who experienced an absolute weight change from the time of listing to transplant were included and classified into two groups by percent weight loss from time of listing to time of transplant using a cut-off of 10%. The primary endpoint was 1-year survival following HT. RESULTS 5951 patients were included in the analysis, of whom 763 (13%) experienced ≥10% weight loss from the time of listing to transplant. Weight loss ≥ 10% was associated with reduced 1-year post-transplant survival (86.9% vs. 91.0%, long-rank p = .0003). Additionally, weight loss ≥ 10% was an independent predictor of 1-year mortality in a multivariable model adjusting for significant risk factors (adjusted HR 1.23, 95% CI 1.04-1.46). In secondary analyses, weight loss ≥ 10% was associated with reduced 1-year survival independent of hospitalized status at time of transplant as well as obesity status at listing (i.e., body mass index [BMI] < 30 kg/m2 and BMI ≥ 30 kg/m2 ). CONCLUSIONS Preoperative weight loss ≥ 10% is associated with reduced survival in patients listed for HT. Nutrition interventions prior to transplant may prove beneficial in this population.
Collapse
Affiliation(s)
- Elissa Driggin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Alice Chung
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Daniella Concha
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Liam Stanton
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Veli K Topkara
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Mathew S Maurer
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Justin A Fried
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Farhana Latif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Koji Takeda
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Gabriel Sayer
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Nir Uriel
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Kevin J Clerkin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| |
Collapse
|
5
|
Abd Alla J, Quitterer U. The RAF Kinase Inhibitor Protein (RKIP): Good as Tumour Suppressor, Bad for the Heart. Cells 2022; 11:cells11040654. [PMID: 35203304 PMCID: PMC8869954 DOI: 10.3390/cells11040654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
The RAF kinase inhibitor protein, RKIP, is a dual inhibitor of the RAF1 kinase and the G protein-coupled receptor kinase 2, GRK2. By inhibition of the RAF1-MAPK (mitogen-activated protein kinase) pathway, RKIP acts as a beneficial tumour suppressor. By inhibition of GRK2, RKIP counteracts GRK2-mediated desensitisation of G protein-coupled receptor (GPCR) signalling. GRK2 inhibition is considered to be cardioprotective under conditions of exaggerated GRK2 activity such as heart failure. However, cardioprotective GRK2 inhibition and pro-survival RAF1-MAPK pathway inhibition counteract each other, because inhibition of the pro-survival RAF1-MAPK cascade is detrimental for the heart. Therefore, the question arises, what is the net effect of these apparently divergent functions of RKIP in vivo? The available data show that, on one hand, GRK2 inhibition promotes cardioprotective signalling in isolated cardiomyocytes. On the other hand, inhibition of the pro-survival RAF1-MAPK pathway by RKIP deteriorates cardiomyocyte viability. In agreement with cardiotoxic effects, endogenous RKIP promotes cardiac fibrosis under conditions of cardiac stress, and transgenic RKIP induces heart dysfunction. Supported by next-generation sequencing (NGS) data of the RKIP-induced cardiac transcriptome, this review provides an overview of different RKIP functions and explains how beneficial GRK2 inhibition can go awry by RAF1-MAPK pathway inhibition. Based on RKIP studies, requirements for the development of a cardioprotective GRK2 inhibitor are deduced.
Collapse
Affiliation(s)
- Joshua Abd Alla
- Molecular Pharmacology, Department of Chemistry and Applied Biosciences, ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland;
| | - Ursula Quitterer
- Molecular Pharmacology, Department of Chemistry and Applied Biosciences, ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland;
- Department of Medicine, Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-632-9801
| |
Collapse
|
6
|
Cai Z, Tu J, Xu L, Lin Y, Deng B, Li F, Chen S, Dong N. Combining Prognostic Nutritional Index and Brain Natriuretic Peptide as a Predicting Tool for Heart Transplantation. J Cardiovasc Dev Dis 2022; 9:jcdd9020040. [PMID: 35200694 PMCID: PMC8879512 DOI: 10.3390/jcdd9020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/09/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Our study aimed to evaluate the potential of prognostic nutritional index (PNI) and Brain natriuretic peptide (BNP) in predicting the prognosis of heart transplantation (HTx). We retrospectively investigated 489 patients undergoing HTx between 2015 and 2020 in our center. The relationship between preoperative index and prognosis was analyzed respectively, the optimal cut-off values for preoperative PNI and BNP level were evaluated with receiver operating curve analysis. Uni-variate analysis and multivariate analysis were used to compare baseline data (sex, age, diagnosis, etc.) of groups divided by the level of PNI and BNP. Propensity score matching (PSM) was applied to eliminate bias. We calculated the C-index from the prediction efficiency of PNI and BNP. During the period, 489 recipients undergoing HTx in our center were included according to the inclusion criteria; 383 (78.3%) males and 106 (21.7%) females were included in this study, with a median age of 47.57 years old. The ROC curve showed that the optimal cut-off values of each indicator were verified as 49.345 for PNI, and 4397.500 for BNP. The multivariate analyses indicated that PNI (p = 0.047), BNP (p = 0.024), age (p = 0.0023), and waiting time (p = 0.012) were risk factors for all-cause death after HTx. Propensity score matching generated 116 pairs based on PNI level and 126 pairs based on BNP level, and the results showed that OS (overall survival) was significantly correlated with PNI (n = 232, p = 0.0113) and BNP (n = 252, p = 0.0146). Our study implied that higher PNI and lower BNP level had direct correlation with better survival after HTx. Combining PNI and BNP together would be a potential clinical preoperative instrument to predict the survival of patients after HTx, especially in short-term survival.
Collapse
Affiliation(s)
- Ziwen Cai
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (J.T.); (L.X.); (F.L.)
| | - Jingrong Tu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (J.T.); (L.X.); (F.L.)
| | - Li Xu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (J.T.); (L.X.); (F.L.)
| | - Yao Lin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
| | - Bowen Deng
- The First Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
| | - Fei Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (J.T.); (L.X.); (F.L.)
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (J.T.); (L.X.); (F.L.)
- Correspondence: (S.C.); (N.D.)
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (J.T.); (L.X.); (F.L.)
- Correspondence: (S.C.); (N.D.)
| |
Collapse
|
7
|
Jafari-Vayghan H, Moludi J, Saleh-Ghadimi S, Enamzadeh E, Seyed-Mohammadzad MH, Alizadeh M. Impact of Melatonin and Branched-Chain Amino Acids Cosupplementation on Quality of Life, Fatigue, and Nutritional Status in Cachectic Heart Failure Patients: A Randomized Controlled Trial. Am J Lifestyle Med 2022; 16:130-140. [PMID: 35185435 PMCID: PMC8848111 DOI: 10.1177/1559827619874044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/23/2024] Open
Abstract
Background: Cardiac cachexia (CC) adversely affects the lifestyle of heart failure (HF) patients. The current study examined the impact of melatonin cosupplementation and branched-chain amino acids (BCAAs) on quality of life (QoL), fatigue, and nutritional status in cachectic HF patients. Methods: In this trial, 84 CC patients were randomized to melatonin, BCAAs, or coadministration (both) as intervention groups and a control group over 8 weeks. At baseline and postintervention, QoL, fatigue, and nutritional status were assessed. Results: After intervention, improvement in the overall and physical dimensions of QoL and appetite score were found to be statistically significant in the BCAAs (P < .001) and the melatonin+BCAAs (P < .001) groups compared with the placebo group. The emotional dimension score was significantly lower in the BCAAs group compared with the placebo group (P = .001). There was a statistically significant improvement in fatigue severity in all 3 intervention groups compared with the placebo group. The nutrition risk index (NRI) score increased significantly only in the melatonin group (P = .015), and there was no significant difference between the other groups (P = .804). Conclusions: Cosupplementation with BCAAs and melatonin improved QoL, fatigue status, and appetite in cachectic HF patients but did not affect NRI.
Collapse
Affiliation(s)
- Hamed Jafari-Vayghan
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Jalal Moludi
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Sevda Saleh-Ghadimi
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Elgar Enamzadeh
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Mir Hossein Seyed-Mohammadzad
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| | - Mohammad Alizadeh
- Student Research Committee (HJ-V, JM), Tabriz University of Medical Sciences, Tabriz, Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences (SS-G), Tabriz University of Medical Sciences, Tabriz, Iran
- Cardiovascular Research Center (EE), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science (MA), Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cardiology, Shohada Hospital, Urmia University of Medical Sciences, Urmia, Iran (MHS-M)
| |
Collapse
|
8
|
Rodriguez-Guerra MA, Pandey N, Vittorio TJ. Cardiac Cachexia Associated With Valvular Heart Failure. Cureus 2021; 13:e20109. [PMID: 35003957 PMCID: PMC8723726 DOI: 10.7759/cureus.20109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/05/2022] Open
Abstract
Cardiac cachexia (CC) represents a serious complication of heart failure (HF). This condition could be directly related to mortality. The weight or muscle mass loss has to be monitored in our patients with HF to avoid potential complications. We report a case of an elderly patient with a history of aortic stenosis (AS) who presented with progressive shortness of breath limiting his daily activities associated with weight loss. Signs of heart failure were evident on physical examination, and valvulopathy was also evident. His echocardiogram showed reduced ejection fraction (EF) with structural changes and severe aortic stenosis. He was not a candidate for cardiothoracic surgery, and a transcatheter aortic valve replacement (TAVR) was performed. After the procedure, his symptoms improved, and during the outpatient follow-up, his cardiac function and dry weight improved. Cardiac cachexia could be caused by reversible cardiomyopathy. Early assessment and approach are critical for the outcome of our patients, impacting their quality of life and outcome in terms of morbidity and mortality consequences.
Collapse
|
9
|
Factors associated with unintentional weight loss among older adults in a geriatric outpatient clinic of university hospital. PLoS One 2021; 16:e0260233. [PMID: 34793549 PMCID: PMC8601429 DOI: 10.1371/journal.pone.0260233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/04/2021] [Indexed: 12/28/2022] Open
Abstract
Background Unintentional weight loss (UWL) is defined as unintentional reduction of more than 5% of baseline body weight over 6 to 12 months. UWL is a common problem in the older adults, resulting in increased rate of morbidity and mortality. With specific reference to Thailand, no information on factors associated with UWL in older adults could be traced. The aims of this research were to identify the factors associated with UWL and to assess the common causes of UWL among older adults in the geriatric outpatient clinic of university hospital. Methods A case-control study was conducted from June 1st, 2020 to December 31st, 2020. Eighty older adults aged 60 years or older were enrolled in the UWL group while the non-UWL group consisted of 160 participants. Data collection was performed by structural questionnaire including baseline characteristics, psychosocial factors, health information, lifestyle behaviors, and medications. The factors associated with UWL were analyzed by using univariate and multivariate logistic regression analysis. Causes of UWL were recorded from electronic medical records. Results The mean age of the 240 participants was 79.6 years (SD 7.4). Most patients were female (79.2%) and had fewer than 12 years of education (62.6%). The three common causes of UWL were reduced appetite (20.1%), dementia and behavioral and psychological symptoms of dementia (13.7%) and medications (11.0%). Multivariate logistic regression analysis showed that a Charlson Comorbidity Index (CCI) score of >1 (OR 2.55, 95% CI 1.37–4.73; P = 0.003), vitamin D deficiency (OR 4.01, 95% CI 1.62–9.97; P = 0.003), and hemoglobin level of <12 g/dL (OR 2.47, 95% CI 1.32–4.63; P = 0.005) were factors significantly associated with UWL. Conclusions Factors associated with UWL were CCI score >1, vitamin D deficiency, and hemoglobin level of <12 g/dl. The early detection of these associated factors, reduced appetite, dementia and polypharmacy may be important in UWL prevention in older adults.
Collapse
|
10
|
Weight changes in heart failure with preserved ejection fraction: findings from TOPCAT. Clin Res Cardiol 2021; 111:451-459. [PMID: 34757487 DOI: 10.1007/s00392-021-01962-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Weight loss has been associated with poor outcomes in patients with heart failure (HF). However, few data are available for patients with heart failure with preserved ejection fraction (HFpEF). The impact of weight gain on outcomes has not been frequently reported either. AIMS To study post-randomization weight changes and how these could impact outcomes and the effect of spironolactone in patients with HFpEF enrolled in the TOPCAT-Americas trial (N = 1767). METHODS Mixed-effects regressions and time-updated Cox models to assess the factors associated with weight changes and their impact on subsequent outcomes. RESULTS Over a median follow-up of 3 years, 824 (47%) patients experienced weight loss ≥ 5% and 390 (22%) experienced weight loss ≥ 10%. Patients experiencing weight loss were older and more frequently women with severe HF symptoms. Spironolactone slightly reduced body weight before 12 months of follow-up: β = - 0.55 (- 0.82 to - 0.29) kg, without effect on weight afterwards: β = 0.01 (- 0.66 to 0.68) kg; treatment-by-time interaction P = 0.0015. Spironolactone did not increase the odds of weight loss but reduced the odds of weight gain. Weight loss ≥ 5% was associated with a higher risk of cardiovascular and all-cause death irrespective of baseline body mass index: HR = 1.47, 95%CI = 1.07-2.01 and HR = 1.84, 95%CI = 1.46-2.31, respectively. Weight gain was not associated with an increased risk of any outcome. CONCLUSION Weight loss ≥ 5% was frequent and independently associated with an increased risk of subsequent mortality. Spironolactone induced only slight body weight reductions early after its introduction and up to a maximum of 8-12 months of follow-up. Association between body weight changes and subsequent death. Legend: HR, hazard ratio from time-updated Cox models. Model adjusted on age, sex, race, NYHA class, systolic blood pressure, diabetes, atrial fibrillation, previous myocardial infarction, previous heart failure hospitalization, estimated glomerular filtration rate, diuretic use, and baseline weight.
Collapse
|
11
|
Dereli S, Bayramoğlu A, Kaya A. Effects of sacubutril/valsartan on nutritional status in heart failure with reduced ejection fraction. J Cardiovasc Med (Hagerstown) 2020; 21:13-20. [PMID: 31714330 DOI: 10.2459/jcm.0000000000000895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Malnutrition commonly occurs in patients with heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan, which is an AT1 neprilysin inhibitor, has been shown to reduce mortality and hospitalization in patients with HFrEF. However, its effects on nutritional status remain unclear. METHODS Sacubitril/valsartan was initiated in 164 symptomatic patients with HFrEF receiving an optimal medical treatment with angiotensin inhibition (mean age: 63 ± 20 years; 120 males, 60% ischemic cause). The New York Heart Association (NYHA) functional class and nutritional statuses of the patients were evaluated at the switching to AT1 neprilysin inhibitor and at the 6th-month follow-up of the maximum sacubitril/valsartan dose using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and prealbumin. RESULTS After the sacubutril/valsartan treatment, a significant reduction in the number (%) of malnourished patients was observed according to CONUT (before 47% vs. after 7%, P < 0.001), GNRI (before 39% vs. after 19%, P < 0.001), PNI scores (before 36% vs. after 12%, P = 0.002), and prealbumin (before 41% vs. after 12%, P < 0.001). Also significant changes were observed at the baseline and follow-up in the mean scores of the three different nutritional indexes and prealbumin levels [CONUT: 2.68 ± 2.5, 1.02 ± 1.0 (P < 0.001); GNRI: 97.1 ± 9.7, 101.2 ± 5.9 (P < 0.001); PNI: 38.8 ± 4.8, 41.6 ± 3.7 (P < 0.001); prealbumin: 14.6 ± 6.9 mg/dl, 17.1 ± 5.2 mg/dl (P < 0.001)]. Overall, the patients exhibited a significant functional improvement following the initiation of sacubitril/valsartan: 23% of the patients improved by two NYHA classes, 48% improved by one NYHA class, and 39% remained stable. CONCLUSION In patients with HFrEF, the switch from angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker therapy to sacubitril/valsartan resulted in a significant improvement in both nutritional and functional statuses.
Collapse
Affiliation(s)
| | - Adil Bayramoğlu
- Deparment of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Ahmet Kaya
- Deparment of Cardiology, Ordu University Faculty of Medicine, Ordu, Turkey
| |
Collapse
|
12
|
Rahmani B, Aghebati N, Esmaily H, Florczak KL. Nurse-led Care Program with Patients with Heart Failure Using Johnson's Behavioral System Model: A Randomized Controlled Trial. Nurs Sci Q 2020; 33:204-214. [PMID: 32605492 DOI: 10.1177/0894318420932102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with heart failure experience system imbalance and have multiple symptoms. A nurse-led care program based on Johnson's behavioral system model was used to improve the balance of the behavioral system of heart failure patients. One hundred and fifty patients were randomly assigned into two groups. In the experimental group, the patient's status was evaluated by a behavioral subsystem assessment tool related to the level of imbalance. The patients in the intervention group received care individually based on their worst subsystem scores over a period of 2 weeks. The results showed significant improvement in restorative, ingestive, eliminative, aggressive/protective, dependency, and achievement (p < .05) subsystems in the experimental group. However, no significant difference was seen in sexual and affiliative (p > .05) subsystems.
Collapse
Affiliation(s)
- Behnoush Rahmani
- MSc Student, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Aghebati
- Assistant professor, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Professor, Department of Biostatistics and Epidemiology, Social Determinants of Health
| | | |
Collapse
|
13
|
Fukui S, Kawakami M, Otaka Y, Ishikawa A, Muraoka K, Yashima F, Hayashida K, Liu M. Malnutrition among elderly patients with severe aortic stenosis. Aging Clin Exp Res 2020; 32:373-379. [PMID: 31148096 DOI: 10.1007/s40520-019-01227-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/16/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Most patients with aortic stenosis (AS) are elderly. To achieve favorable outcomes after interventional treatments, careful management including adequate nutritional support is required. However, there has been a lack of knowledge about the prevalence of malnutrition and factors related to it. AIMS To explore the prevalence of malnutrition and its related factors in patients with severe AS. METHODS This was a single-institution, cross-sectional study. A total of 300 consecutive older patients (mean age, 83.8 ± 0.5 years) with AS were prospectively enrolled. Nutritional status was evaluated with the Mini Nutritional Assessment-Short Form (MNA-SF). Cardiac, kidney, physical, cognitive functions, instrumental activities of daily living (IADL) as measured with the Frenchay Activities Index (FAI), medical history, and comorbidities were evaluated as potentially related factors. Multiple logistic regression analysis was performed to identify factors that were significantly associated with the MNA-SF. RESULTS The mean (SD) score of the MNA-SF was 10.9 (2.5). 34 patients (11.3%) and 127 patients (42.3%) met the criteria for malnutrition and at risk of malnutrition, respectively. On multiple logistic regression analysis, female sex (OR 3.455, 95% CI 1.045-11.42, P = 0.042), NYHA class (OR 3.625, 95% CI 1.627-8.074, P = 0.002), left ventricular ejection fraction (/10%) (OR 0.961, 95% CI 0.932-0.991, P = 0.010), and FAI score (/10 points) (OR 0.911, 95% CI 0.864-0.961, P < 0.001) were significantly related to malnutrition. CONCLUSIONS The prevalence of malnutrition was high among older persons with severe AS, and female sex, poor cardiac function, and lower IADL were independently related to it.
Collapse
Affiliation(s)
- Shogo Fukui
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kaori Muraoka
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
14
|
Carson MA, Reid J, Hill L, Fitzsimons D. The need for a specific definition of cardiac cachexia. Eur J Cardiovasc Nurs 2019; 18:524-525. [PMID: 31342762 DOI: 10.1177/1474515119866686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Matthew A Carson
- Queen's University Belfast, Faculty of Medicine Health and Life Sciences, UK
| | - Joanne Reid
- Queen's University Belfast, Faculty of Medicine Health and Life Sciences, UK
| | - Loreena Hill
- Queen's University Belfast, Faculty of Medicine Health and Life Sciences, UK
| | - Donna Fitzsimons
- Queen's University Belfast, Faculty of Medicine Health and Life Sciences, UK
| |
Collapse
|
15
|
Jafari‐Vayghan H, Saleh‐Ghadimi S, Maleki V, Moludi J, Alizadeh M. The effects of melatonin on neurohormonal regulation in cardiac cachexia: A mechanistic review. J Cell Biochem 2019; 120:16340-16351. [DOI: 10.1002/jcb.29151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Hamed Jafari‐Vayghan
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science Tabriz University of Medical Sciences Tabriz Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences Tabriz University of Medical Sciences Tabriz Iran
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Sevda Saleh‐Ghadimi
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Vahid Maleki
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Jalal Moludi
- Department of Nutrition, Faculty of Nutrition Sciences and Food Technology Kermanshah University of Medical Sciences Kermanshah Iran
| | - Mohammad Alizadeh
- Department of Clinical Nutrition, Faculty of Nutrition and Food Science Tabriz University of Medical Sciences Tabriz Iran
- Nutrition Research Center, Faculty of Nutrition and Food Sciences Tabriz University of Medical Sciences Tabriz Iran
| |
Collapse
|
16
|
Rolfe M, Kamel A, Ahmed MM, Kramer J. Pharmacological management of cardiac cachexia: a review of potential therapy options. Heart Fail Rev 2019; 24:617-623. [DOI: 10.1007/s10741-019-09784-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
17
|
Selthofer-Relatić K, Kibel A, Delić-Brkljačić D, Bošnjak I. Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link? J Obes 2019; 2019:9854085. [PMID: 31565432 PMCID: PMC6745151 DOI: 10.1155/2019/9854085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
Obesity is a risk factor for cardiometabolic and vascular diseases like arterial hypertension, diabetes mellitus type 2, dyslipidaemia, and atherosclerosis. A special role in obesity-related syndromes is played by cardiac visceral obesity, which includes epicardial adipose tissue and intramyocardial fat, leading to cardiac steatosis; hypertensive heart disease; atherosclerosis of epicardial coronary artery disease; and ischemic cardiomyopathy, cardiac microcirculatory dysfunction, diabetic cardiomyopathy, and atrial fibrillation. Cardiac expression of these changes in any given patient is unique and multimodal, varying in clinical settings and level of expressed changes, with heart failure development depending on pathophysiological mechanisms with preserved, midrange, or reduced ejection fraction. Progressive heart failure with misbalanced metabolic and catabolic processes will change muscle, bone, and fat mass and function, with possible changes in the cardiac fat state from excessive accumulation to reduction and cardiac cachexia with a worse prognosis. The question we address is whether cardiac obesity or cardiac cachexia is to be more feared.
Collapse
Affiliation(s)
- K. Selthofer-Relatić
- Department for Cardiovascular Disease, University Hospital Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
- Department for Internal Medicine, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - A. Kibel
- Department for Cardiovascular Disease, University Hospital Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
- Department for Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - D. Delić-Brkljačić
- Department for Internal Medicine, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Clinic for Cardiology, University Hospital “Sestre Milosrdnice”, Vinogradska Cesta 29, 10000 Zagreb, Croatia
| | - I. Bošnjak
- Department for Cardiovascular Disease, University Hospital Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| |
Collapse
|
18
|
Mansur AJ. Adropin and Irisin in Patients with Cardiac Cachexia. Arq Bras Cardiol 2018; 111:48-49. [PMID: 30110044 PMCID: PMC6078362 DOI: 10.5935/abc.20180109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Alfredo José Mansur
- Instituto do Coração (InCor) do Hospital das
Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC
FMUSP), São Paulo, SP – Brazil
| |
Collapse
|
19
|
Abstract
Recent studies have suggested that undernutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). The evidence supporting this correlation is unclear. Therefore, we conducted this systematic review to critically appraise the use of multidimensional evaluation tools in the prediction of clinical outcomes in HF. We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results. We identified 17 articles with qualitative analyses and 11 with quantitative analysis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range 16-90 %), particularly in advanced and acute decompensated HF (approximate range 75-90 %). Undernutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutritional Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32, 95 % CI 2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF. Moreover, undernutrition as identified by multidimensional evaluation tools is significantly associated with unfavourable prognoses and high mortality in HF.
Collapse
|
20
|
No Obesity Paradox in Pediatric Patients With Dilated Cardiomyopathy. JACC-HEART FAILURE 2018; 6:222-230. [PMID: 29428438 DOI: 10.1016/j.jchf.2017.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to examine the role of nutrition in pediatric dilated cardiomyopathy (DCM). BACKGROUND In adults with DCM, malnutrition is associated with mortality, whereas obesity is associated with survival. METHODS The National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry was used to identify patients with DCM and categorized by anthropometric measurements: malnourished (MN) (body mass index [BMI] <5% for age ≥2 years or weight-for-length <5% for <2 years), obesity (BMI >95% for age ≥2 years or weight-for-length >95% for <2 years), or normal bodyweight (NB). Of 904 patients with DCM, 23.7% (n = 214) were MN, 13.3% (n=120) were obese, and 63.1% (n=570) were NB. RESULTS Obese patients were older (9.0 vs. 5.7 years for NB; p < 0.001) and more likely to have a family history of DCM (36.1% vs. 23.5% for NB; p = 0.023). MN patients were younger (2.7 years vs. 5.7 years for NB; p < 0.001) and more likely to have heart failure (79.9% vs. 69.7% for NB; p = 0.012), cardiac dimension z-scores >2, and higher ventricular mass compared with NB. In multivariable analysis, MN was associated with increased risk of death (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.66 to 3.65; p < 0.001); whereas obesity was not (HR: 1.49; 95% CI: 0.72 to 3.08). Competing outcomes analysis demonstrated increased risk of mortality for MN compared with NB (p = 0.03), but no difference in transplant rate (p = 0.159). CONCLUSIONS Malnutrition is associated with increased mortality and other unfavorable echocardiographic and clinical outcomes compared with those of NB. The same effect of obesity on survival was not observed. Further studies are needed investigating the long-term impact of abnormal anthropometric measurements on outcomes in pediatric DCM. (Pediatric Cardiomyopathy Registry; NCT00005391).
Collapse
|
21
|
Nwachukwu ID, Kouritzin TM, Aluko RE, Myrie SB. The role of omega-3 fatty acids in skeletal muscle anabolism, strength, and function in healthy and diseased states. J Food Biochem 2017. [DOI: 10.1111/jfbc.12435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ifeanyi D. Nwachukwu
- Department of Human Nutritional Sciences; University of Manitoba; Winnipeg Canada
- Richardson Centre for Functional Foods and Nutraceuticals; University of Manitoba; Winnipeg Canada
| | - Trevor M. Kouritzin
- Department of Human Nutritional Sciences; University of Manitoba; Winnipeg Canada
- Richardson Centre for Functional Foods and Nutraceuticals; University of Manitoba; Winnipeg Canada
| | - Rotimi E. Aluko
- Department of Human Nutritional Sciences; University of Manitoba; Winnipeg Canada
- Richardson Centre for Functional Foods and Nutraceuticals; University of Manitoba; Winnipeg Canada
| | - Semone B. Myrie
- Department of Human Nutritional Sciences; University of Manitoba; Winnipeg Canada
- Richardson Centre for Functional Foods and Nutraceuticals; University of Manitoba; Winnipeg Canada
| |
Collapse
|
22
|
González-Robledo G, León J, Buitrago AF, Carvajalino S, Abril D, González V, Morales D, Parra J, Santacruz JG. Cuidado paliativo en falla cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
23
|
Natella PA, Le Corvoisier P, Paillaud E, Renaud B, Mahé I, Bergmann JF, Perchet H, Mottier D, Montagne O, Bastuji-Garin S. Long-term mortality in older patients discharged after acute decompensated heart failure: a prospective cohort study. BMC Geriatr 2017; 17:34. [PMID: 28125958 PMCID: PMC5270303 DOI: 10.1186/s12877-017-0419-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data are available on short- and intermediate-term mortality rates after discharge for acutely decompensated heart failure (ADHF). However, few studies specifically addressed ADHF outcomes in patients aged 75 years or over, who contribute more than half of all ADHF admissions. Our objectives here were to estimate the long-term mortality of patients aged 75 years or over who were discharged after admission for ADHF and to identify factors, especially geriatric findings, independently associated with 2-year mortality. METHODS This prospective cohort study in five French hospitals included consecutive patients aged 75 years or older and discharged after emergency-department admission for ADHF meeting Framingham criteria (N = 478; median age, 85 years; 68% female). Kaplan-Meier 1-year and 2-year survival curves were plotted. Admission characteristics independently associated with overall 2-year mortality were identified using multivariable Cox proportional-hazards regression. RESULTS Mortality was 41.7% (95% confidence interval [95% CI], 37.2%-53.5%) after 1 year and 56.0% (95% CI, 51.5%-60.7%) after 2 years. By multivariable analysis, independent predictors of 2-year mortality were male sex (hazard ratio [HR], 1.36; 95% CI, 1.00-1.82), age >85 years (HR, 1.57; 95% CI, 1.19-2.07), higher number of impaired activities of daily living (HR, 1.11 per impaired item; 95% CI, 1.05-1.17), recent weight loss (HR, 1.61; 95% CI, 1.14-2.28), and lower systolic blood pressure (HR, 0.86 per standard deviation increase; 95% CI, 0.74-0.99). Creatinine clearance ≤30 mL/min showed a trend toward an association with 2-year mortality (HR, 1.36; 95% CI, 0.97-2.00). CONCLUSION Functional impairment before admission is associated with higher long-term mortality in patients ≥75 years admitted for ADHF. This study focused on geriatric markers not traditionally collected in heart-failure patients but did not analyse all cardiologic parameters associated with outcomes in other studies. Nevertheless, our findings may contribute to identify those patients admitted for ADHF who have the worst prognosis.
Collapse
Affiliation(s)
- Pierre-André Natella
- Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Philippe Le Corvoisier
- Inserm, Centre d’Investigation Clinique, 1430 Créteil, France
- AP-HP, Hôpital Henri Mondor, Pôle Vigilance Recherche Méthodologie & Information Médicale, 94010 Créteil, France
| | - Elena Paillaud
- Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France
- AP-HP, Hôpital Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, France
| | - Bertrand Renaud
- AP-HP, Hôpital Henri Mondor, Structure des Urgences, Créteil, France
| | - Isabelle Mahé
- AP-HP, Hôpital Lariboisière-Fernand Widal, Département de Médecine Interne, Paris, France
- Université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-François Bergmann
- AP-HP, Hôpital Lariboisière-Fernand Widal, Département de Médecine Interne, Paris, France
- Université Paris 7, EA REMES Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Hervé Perchet
- Centre hospitalier de Meaux, Service de Cardiologie, Meaux, France
| | - Dominique Mottier
- CHU Brest, Hôpital Cavale Blanche, Département de Médecine Interne et de Pneumologie, Brest, France
- Université de Bretagne Occidentale, EA 3878 (GETBO), Brest, France
| | - Olivier Montagne
- Inserm, Centre d’Investigation Clinique, 1430 Créteil, France
- AP-HP, Hôpital Henri Mondor, Pôle Vigilance Recherche Méthodologie & Information Médicale, 94010 Créteil, France
| | - Sylvie Bastuji-Garin
- Université Paris Est (UPEC), A-TVB DHU, IMRB, EA7376, CEpiA Clinical Epidemiology and Ageing unit, Créteil, France
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique, Créteil, France
| |
Collapse
|
24
|
Circulating sex hormones, alcohol consumption and echocardiographic parameters of cardiac function in men with heart failure. Int J Cardiol 2016; 224:245-251. [DOI: 10.1016/j.ijcard.2016.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 08/24/2016] [Accepted: 09/15/2016] [Indexed: 01/19/2023]
|
25
|
Springer J, Anker SD. Publication trends in cachexia and sarcopenia in elderly heart failure patients. Wien Klin Wochenschr 2016; 128:446-454. [PMID: 27885423 DOI: 10.1007/s00508-016-1126-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022]
Abstract
The loss of skeletal mass - sarcopenia and cachexia - is considered to be a major contributor to morbidity and mortality in chronic heart failure (CHF). Unfortunately, sarcopenia is generally considered to be a geriatric syndrome, but not necessarily seen as a comorbidity in CHF, even though it has a wide range of adverse health outcomes. While there were 15,574 publication with the title word "heart failure" in PubMed in the 5‑year period from 1 June 2011 to 31 May 2016, only 22 or 71 publications were found with the search combination "sarcopenia" or "cachexia" (title word) and "heart failure" (all fields), respectively. This shows very clearly that loss of muscle quality and function due to heart failure is still an underappreciated problem in the medical field.
Collapse
Affiliation(s)
- Jochen Springer
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Stefan D Anker
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| |
Collapse
|
26
|
Mansson JV, Alves FD, Biolo A, Souza GC. Use of ghrelin in cachexia syndrome: a systematic review of clinical trials. Nutr Rev 2016; 74:659-669. [DOI: 10.1093/nutrit/nuw029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
27
|
Lee HS, Visco F, Mushiyev S, Pekler G, Savadkar A, Cativo EH, Garay HAR. The Obesity Paradox in Heart Failure: What Is Real Obesity in Heart Failure? CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Mackman CA, Loomba RS, Slicker J, Bartz PJ. Growth Trajectory in Children with Trisomy 21 with and without Atrioventricular Septal Defect. CONGENIT HEART DIS 2016; 11:348-53. [DOI: 10.1111/chd.12378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Chad A. Mackman
- Pediatric Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee Wis USA
| | - Rohit S. Loomba
- Pediatric Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee Wis USA
| | - Julie Slicker
- Pediatric Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee Wis USA
| | - Peter J. Bartz
- Pediatric Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin; Milwaukee Wis USA
| |
Collapse
|
29
|
Zamora E, Díez-López C, Lupón J, de Antonio M, Domingo M, Santesmases J, Troya MI, Díez-Quevedo C, Altimir S, Bayes-Genis A. Weight Loss in Obese Patients With Heart Failure. J Am Heart Assoc 2016; 5:e002468. [PMID: 27013541 PMCID: PMC4943237 DOI: 10.1161/jaha.115.002468] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In heart failure (HF), weight loss (WL) has been associated with an adverse prognosis whereas obesity has been linked to lower mortality (the obesity paradox). The impact of WL in obese patients with HF is incompletely understood. Our objective was to explore the prevalence of WL and its impact on long-term mortality, with an emphasis on obese patients, in a cohort of patients with chronic HF. METHODS AND RESULTS Weight at first visit and the 1-year follow-up and vital status after 3 years were assessed in 1000 consecutive ambulatory, chronic HF patients (72.7% men; mean age 65.8±12.1 years). Significant WL was defined as a loss of ≥5% weight between baseline and 1 year. Obesity was defined as body mass index ≥30 kg/m(2) (N=272). Of the 1000 patients included, 170 experienced significant WL during the first year of follow-up. Mortality was significantly higher in patients with significant WL (27.6% versus 15.3%, P<0.001). In univariable Cox regression analysis, patients with significant WL had 2-fold higher mortality (hazard ratio 1.95 [95% CI 1.39-2.72], P<0.001). In multivariable analysis, adjusting for age, sex, body mass index, New York Heart Association functional class, left ventricular ejection fraction, HF duration, ischemic etiology, diabetes, and treatment, significant WL remained independently associated with higher mortality (hazard ratio 1.89 [95% CI 1.32-2.68], P<0.001). Among obese patients with HF, significant WL was associated with an even more ominous prognosis (adjusted hazard ratio for death of 2.38 [95% CI 1.31-4.32], P=0.004) than that observed in nonobese patients (adjusted hazard ratio 1.83 [95% CI 1.16-2.89], P=0.01). CONCLUSIONS Weight loss ≥5% in patients with chronic HF was associated with high long-term mortality, particularly among obese patients with HF.
Collapse
Affiliation(s)
- Elisabet Zamora
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carles Díez-López
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain
| | - Josep Lupón
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain
| | - Mar Domingo
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain
| | - Javier Santesmases
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain
| | - María Isabel Troya
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain
| | - Crisanto Díez-Quevedo
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador Altimir
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
30
|
Rozentryt P, Niedziela JT, Hudzik B, Lekston A, Doehner W, Jankowska EA, Nowak J, von Haehling S, Partyka R, Rywik T, Anker SD, Ponikowski P, Poloński L. Higher serum phosphorus is associated with catabolic/anabolic imbalance in heart failure. J Cachexia Sarcopenia Muscle 2015; 6:325-34. [PMID: 26672973 PMCID: PMC4670741 DOI: 10.1002/jcsm.12026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/06/2014] [Accepted: 02/20/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A higher serum phosphate level is associated with worse outcome. Energy-demanding intracellular transport of phosphate is needed to secure anion bioavailability. In heart failure (HF), energy starvation may modify intracellular and serum levels of phosphate. We analysed determinants of serum phosphates in HF and assessed if catabolic/anabolic balance (CAB) was associated with elevation of serum phosphate. METHODS We retrospectively reviewed data from 1029 stable patients with HF and have calculated negative (loss) and positive (gain) components of weight change from the onset of HF till index date. The algebraic sum of these components was taken as CAB. The univariate and multivariable predictors of serum phosphorus were calculated. In quintiles of CAB, we have estimated odds ratios for serum phosphorus above levels previously identified to increase risk of mortality. As a reference, we have selected a CAB quintile with similar loss and gain. RESULTS Apart from sex, age, and kidney function, we identified serum sodium, N-terminal fragment of pro-brain-type natriuretic peptide, and CAB as independent predictors of serum phosphorus. The odds for serum phosphorus above thresholds found in literature to increase risk were highest in more catabolic patients. In most catabolic quintile relative to neutral balance, the odds across selected phosphorus thresholds rose, gradually peaking at 1.30 mmol/L with a value of 3.29 (95% confidence interval: 2.00-5.40, P < 0.0001) in an unadjusted analysis and 2.55 (95% confidence interval: 1.38-2.72, P = 0.002) in a fully adjusted model. CONCLUSIONS Metabolic status is an independent determinant of serum phosphorus in HF. Higher catabolism is associated with serum phosphorus above mortality risk-increasing thresholds.
Collapse
Affiliation(s)
- Piotr Rozentryt
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland
| | - Jacek T Niedziela
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland
| | - Bartosz Hudzik
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland
| | - Wolfram Doehner
- Centre for Stroke Research Berlin, Charité Medical School Berlin, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University Wroclaw, Poland
| | - Jolanta Nowak
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland
| | - Stephan von Haehling
- Division of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany
| | - Robert Partyka
- Clinical Division of Anaesthesiology and Intensive Therapy of the Department of Anesthesiology, Intensive Treatment and Emergency Medicine, Medical University of Silesia Zabrze, Poland
| | - Tomasz Rywik
- Department of Heart Failure and Transplantology, Institute of Cardiology Warsaw, Poland
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University Wroclaw, Poland
| | - Lech Poloński
- Third Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia Zabrze, Poland
| |
Collapse
|
31
|
Narumi T, Watanabe T, Kadowaki S, Takahashi T, Yokoyama M, Kinoshita D, Honda Y, Funayama A, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Miyamoto T, Kubota I. Sarcopenia evaluated by fat-free mass index is an important prognostic factor in patients with chronic heart failure. Eur J Intern Med 2015; 26:118-22. [PMID: 25657117 DOI: 10.1016/j.ejim.2015.01.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/25/2014] [Accepted: 01/22/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIM Chronic heart failure (CHF) is a major cause of morbidity and mortality, and cardiac cachexia and sarcopenia are serious complications associated with weight loss and increased catabolism. Fat-free mass index (FFMI) is an indicator of resting energy expenditure and is used for the clinical diagnosis of sarcopenia. In the present study, we investigated the impact of sarcopenia, as evaluated by FFMI, on cardiac prognosis in patients with CHF. METHODS AND RESULTS We calculated FFMI in 267 CHF patients who were prospectively followed until they died due to cardiac event, or until they were re-hospitalized. Fat-free mass (FFM) was estimated by the formula [FFM (kg)=7.38+0.02908×urinary creatinine (mg/day)] and normalized by the square of the patient's height in meters to calculate FFMI. During the follow-up periods, there were 83 cardiac events, including 19 cardiac deaths. FFMI was lower in patients with cardiac events than in those without (17.0 kg/m(2) vs. 17.6 kg/m(2), P=0.045). Multivariate Cox hazard analysis revealed that decreased FFMI was associated with an unfavorable outcome (adjusted hazard ratio 0.68, 95% confidence interval 0.47-0.98). The patients were divided into two groups according to their median FFMI. The Kaplan-Meier analysis revealed that significantly higher cardiac event rate was observed in the low-FFMI group (log-rank test, P=0.017). CONCLUSIONS Decreased FFMI was associated with an unfavorable prognosis in patients with CHF.
Collapse
Affiliation(s)
- Taro Narumi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Shinpei Kadowaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsuya Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Miyuki Yokoyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Daisuke Kinoshita
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yuki Honda
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Akira Funayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| |
Collapse
|
32
|
Rossignol P, Masson S, Barlera S, Girerd N, Castelnovo A, Zannad F, Clemenza F, Tognoni G, Anand IS, Cohn JN, Anker SD, Tavazzi L, Latini R. Loss in body weight is an independent prognostic factor for mortality in chronic heart failure: insights from the GISSI-HF and Val-HeFT trials. Eur J Heart Fail 2015; 17:424-33. [DOI: 10.1002/ejhf.240] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/21/2014] [Accepted: 01/05/2015] [Indexed: 01/06/2023] Open
Affiliation(s)
- Patrick Rossignol
- INSERM; Centre d'Investigations Cliniques-Plurithématique 1433; Nancy France
- Université de Lorraine; France
- INSERM U1116; Nancy France
| | - Serge Masson
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Simona Barlera
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Nicolas Girerd
- INSERM; Centre d'Investigations Cliniques-Plurithématique 1433; Nancy France
- Université de Lorraine; France
- INSERM U1116; Nancy France
| | - Angelo Castelnovo
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Faiez Zannad
- INSERM; Centre d'Investigations Cliniques-Plurithématique 1433; Nancy France
- Université de Lorraine; France
- INSERM U1116; Nancy France
| | - Francesco Clemenza
- Heart Failure Unit-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione); Palermo Italy
| | | | - Inder S. Anand
- Veterans Affairs Medical Center and University of Minnesota; Minneapolis MN USA
| | - Jay N. Cohn
- Cardiovascular Division; University of Minnesota Medical School; Minneapolis MN USA
| | - Stefan D. Anker
- Department of Innovative Clinical Trials; University Medical Centre Göttingen; Göttingen Germany
- Institute of Diabetes for Older People (IDOP); University of Bedfordshire; UK
| | - Luigi Tavazzi
- GVM Hospitals of Care and Research; E.S Health Science Foundation; Cotignola Italy
| | - Roberto Latini
- Department of Cardiovascular Research; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | | |
Collapse
|
33
|
Affiliation(s)
- R P Vincent
- King's College Hospital NHS Foundation Trust, London, UK.
| |
Collapse
|
34
|
|
35
|
Abstract
Almost 20 years ago, the protein encoded by the ob locus in mice was identified as an adipocyte-secreted hormone, now termed leptin, which functions as a peripheral signal to communicate the organism's energy reserve--and thereby protects against starvation due to insufficient caloric resources. Additional peripheral factors have since been identified that coordinate interorgan crosstalk to manage energy resources. The heart is included in this network through its regulated release of natriuretic peptides A and B--cardiac hormones originally identified as important in blood pressure control. Emerging evidence that natriuretic peptide receptors are expressed in adipose tissue, and that circulating levels of these peptides are decreased in animals and humans with obesity, could imply that natriuretic peptides are also involved in the regulation of energy metabolism. The natriuretic peptides stimulate triglyceride lipolysis in adipocytes, a process also regulated by the sympathetic nervous system. In addition, these two pathways promote uncoupling of mitochondrial respiration and thermogenesis in brown adipocytes. This Review focuses on the roles of the natriuretic peptides and the sympathetic nervous system in regulating adipocyte metabolism. The potential for manipulating the natriuretic peptide pathway to increase energy expenditure in obesity and manage the complications of cardiometabolic disease is also discussed.
Collapse
Affiliation(s)
- Sheila Collins
- Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Institute, 6400 Sanger Road, Orlando, FL 32827, USA
| |
Collapse
|
36
|
Azhar G, Wei JY. New Approaches to Treating Cardiac Cachexia in the Older Patient. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:480-484. [PMID: 24489977 PMCID: PMC3904377 DOI: 10.1007/s12170-013-0353-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Congestive heart failure (CHF) is a leading cause of morbidity and mortality in the elderly, accounting for more hospitalizations than any other condition. Advanced stages of congestive heart failure can be associated with serious complications such as cardiac cachexia (defined here as unintentional weight loss of more than 6% in 6 months). Cardiac cachexia and the associated progressive weight loss are sometimes overlooked by older patients, their families and care providers. A delay in the diagnosis can result in further loss of vital organ tissue, progressive weakness, fall-related injuries and even long-term care institutionalization and/or death. During the past several years, researchers have begun to broaden their understanding of this common, morbid and often fatal condition, and these findings will help to characterize the features that assist in its diagnosis, minimize its exacerbation, delay the progressive decline, and educate clinicians about the potential management options.
Collapse
Affiliation(s)
- Gohar Azhar
- Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences (UAMS), and Geriatric Research Education and Clinical Center (GRECC), VISN 16, Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA
| | - Jeanne Y Wei
- Reynolds Department of Geriatrics, University of Arkansas for Medical Sciences (UAMS), and Geriatric Research Education and Clinical Center (GRECC), VISN 16, Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, USA
| |
Collapse
|