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Vest AR, Wong WW, Chery J, Coston A, Telfer L, Lawrence M, Celkupa D, Kiernan MS, Couper G, Kawabori M, Saltzman E. Skeletal Muscle Mass Recovery Early After Left Ventricular Assist Device Implantation in Patients With Advanced Systolic Heart Failure. Circ Heart Fail 2022; 15:e009012. [PMID: 35378982 PMCID: PMC9117416 DOI: 10.1161/circheartfailure.121.009012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with advanced systolic heart failure are at risk of unintentional weight loss and muscle wasting. It has been observed that left ventricular assist device (LVAD) recipients gain weight after device implantation, although it is unknown whether this represents skeletal muscle mass gains. We aimed to determine whether skeletal muscle mass increases early during LVAD support. METHODS We prospectively recruited 30 adults with systolic heart failure ±21 days from LVAD implantation. Participants underwent whole-body dual X-ray absorptiometry to measure fat free mass, appendicular lean mass (ALM, lean mass in the arms and legs) and fat mass. Dual X-ray absorptiometry imaging was repeated at 3 and 6 months after LVAD implantation, with participation ending after the 6-month visit or heart transplantation, whichever occurred first. Changes in body composition were evaluated using mixed effects linear regression models. RESULTS The cohort was 87% male, with mean age 56±12 (SD) years, and mean body mass index 26.4±5.4 kg/m2. Per sarcopenia ALM criteria, 52% of participants had muscle wasting at baseline. At baseline, mean fat free mass and ALM were 56.4±11.7 and 21.0±5.3 kg, respectively. Both measures increased significantly (P<0.001) over 6 months of LVAD support: mean fat free mass change at 3 and 6 months: 2.3 kg (95% CI, 1.0-3.5) and 4.2 kg (95% CI, 2.2-6.1); mean ALM change at 3 and 6 months: 1.5 kg (95% CI, 0.7-2.3) and 2.3 kg (95% CI, 0.9-3.6). CONCLUSIONS Among LVAD recipients with advanced systolic heart failure and high baseline prevalence of muscle wasting, there were significant gains in skeletal muscle mass, as represented by dual X-ray absorptiometry fat free mass and ALM, over the first 6 months of LVAD support.
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Affiliation(s)
- Amanda R Vest
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - William W Wong
- Department of Pediatrics, US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX (W.W.W.)
| | - Joronia Chery
- Tufts University School of Medicine, Boston, MA (J.C., A.C.)
| | - Alex Coston
- Tufts University School of Medicine, Boston, MA (J.C., A.C.)
| | - Laura Telfer
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Matthew Lawrence
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Didjana Celkupa
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Michael S Kiernan
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Gregory Couper
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Masashi Kawabori
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Edward Saltzman
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA (E.S.)
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Masarone D, Petraio A, Fiorentino A, Dellegrottaglie S, Valente F, Ammendola E, Nigro G, Pacileo G. Use of Cardiac Contractility Modulation as Bridge to Transplant in an Obese Patient With Advanced Heart Failure: A Case Report. Front Cardiovasc Med 2022; 9:833143. [PMID: 35252403 PMCID: PMC8889036 DOI: 10.3389/fcvm.2022.833143] [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: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac contractility modulation (CCM) is a novel device-based therapy in patients with heart failure with reduced ejection fraction (HFrEF). In randomized clinical trials and real-life studies, CCM has been shown to improve exercise tolerance and quality of life, reverse left ventricular remodeling and reduce hospitalization in patients with HFrEF. In this case report, we describe for the first time the use of CCM as a “bridge to transplant” in a young obese patient with advanced heart failure due to non-ischemic dilated cardiomyopathy. The patient had a poor quality of life and frequent heart failure-related hospitalizations despite the optimal medical therapy and, due to obesity, a suitable heart donor was unlikely to be identified in the short term and due to severe obesity risk of complications after implantation of a left ventricular assist device (LVAD) was very high.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
- *Correspondence: Daniele Masarone
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, Naples, Italy
- Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Ernesto Ammendola
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
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