1
|
Gagnemo Persson R, Drevenhorn E, Rosén H. Experience and the nutritional relevance of protein-enriched ice cream in patients with heart failure - A pilot study. Heliyon 2024; 10:e33661. [PMID: 39040298 PMCID: PMC11261034 DOI: 10.1016/j.heliyon.2024.e33661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Background Patients with heart failure have a greater risk of malnutrition and need an enhanced intake of nutrients. Purpose The purpose of the study was to describe how patients admitted to a cardiac intensive care unit with heart failure, experience the intake of a protein-enriched ice cream, served as an in-between meal, and to explore this diet supplement's nutritional relevance in these patients. Method In the pilot study, interviews, and collection of diaries with both a qualitative and quantitative approach were used. Inductive, qualitative content analysis was performed of the interviews while data from the diaries were analysed with descriptive analysis. Results The enriched ice cream supplement was perceived as appealing and tasty despite the patients illness and malaise. Different opinions about consistency were experienced according to the patients' individual condition and they made further flavour suggestions. The patients ingested between 500 and 2550 ml each of the ice cream during the study period. Conclusion The patients' experiences can be valuable in order to improve the in-between meal/food snack thus improving the nutritional status of weak patients lacking appetite. The method used requires to be further developed to assess nutritional relevance for patients when consuming a protein-enriched ice cream.
Collapse
Affiliation(s)
| | - Eva Drevenhorn
- Dept of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Helena Rosén
- Dept of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Maeda D, Fujimoto Y, Nakade T, Abe T, Ishihara S, Jujo K, Matsue Y. Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure. Korean Circ J 2024; 54:363-381. [PMID: 38767446 PMCID: PMC11252634 DOI: 10.4070/kcj.2024.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILE-HF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.
Collapse
Affiliation(s)
- Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taisuke Nakade
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuro Abe
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shiro Ishihara
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kentaro Jujo
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| |
Collapse
|
3
|
Ishida Y, Maeda K, Murotani K, Shimizu A, Ueshima J, Nagano A, Inoue T, Mori N. Predicting Mortality Risks Using Body Mass Index and Weight Loss at Admission in Patients with Heart Failure. Ann Geriatr Med Res 2024; 28:171-177. [PMID: 38475664 PMCID: PMC11217663 DOI: 10.4235/agmr.23.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The association of the combination of body mass index (BMI) and weight change at admission with prognoses in patients with heart failure (HF) is unclear. Therefore, we investigated whether BMI and weight changes at admission affect mortality in patients with HF. METHODS This retrospective cohort study lasted 99 months, starting in April 2014, and included 4,862 patients with HF from a Japanese real-world database. Cubic and thin-plate smoothing spline analyses were performed to investigate the association of BMI and weight changes with mortality. The percentage weight change was calculated every 6 months. The study outcome was the presence or absence of death. RESULTS The patients' mean age was 81.5±9.6 years, and 1,239 (25.5%) patients died. Cubic spline analysis revealed a negative correlation of BMI with mortality hazard ratio (HR) (BMI of 18.5 kg/m2 and 25 kg/m2; HR=1.3 [1.2-1.4] and 0.8 [0.7-0.9], respectively). Cubic spline analysis of weight change showed that weight loss tended to increase the mortality HR (each 6% decrease in weight change rate was associated with a 1.1 times higher mortality risk (95% CI [1.0-1.2]) Thin-plate smoothing spline analysis showed that the odds ratio (OR) negatively correlated with BMI (1-year mortality: BMI of 18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.5, 1.0, and 0.7, respectively; 2-year mortality: BMI=18.5 kg/m2, 22 kg/m2, and 25 kg/m2; OR at 0% weight change=1.4, 0.9, and 0.7, respectively). CONCLUSION A low BMI in patients with HF was associated with a higher risk of mortality. Weight loss in patients, regardless of BMI, was associated with a higher OR for mortality.
Collapse
Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Nutritional Therapy Support Center, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu Aichi, Japan
| | - Kenta Murotani
- School of Medical Technology, Kurume University, Fukuoka, Japan
- Biostatistics Center, Kurume University, Kurume, Fukuoka, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nutritional Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ayano Nagano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Shimamicho, Niigata, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
- Nutritional Therapy Support Center, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
4
|
Palazzuoli A, Ruocco G, Del Buono MG, Pavoncelli S, Delcuratolo E, Abbate A, Lavie CJ. The role and application of current pharmacological management in patients with advanced heart failure. Heart Fail Rev 2024; 29:535-548. [PMID: 38285236 DOI: 10.1007/s10741-024-10383-0] [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] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
In the last decades, several classifications and definitions have been proposed for advanced heart failure (ADVHF) patients, including clinical, functional, hemodynamic, imaging, and electrocardiographic features. Despite different inclusion criteria, ADVHF is characterized by some common items, such as drug intolerance, low arterial pressure, multiple organ dysfunction, chronic kidney disease, and diuretic use dependency. Additional features include fatigue, hypotension, hyponatremia, and unintentional weight loss associated with a specific laboratory profile reflecting systemic multiorgan dysfunction. Notably, studies evaluating guideline-directed medical therapy recently endorsed by guidelines in stable HF, including the 4 drug classes all together (i.e., betablocker, mineral corticoid antagonist, renin angiotensin inhibitors/neprilysin inhibitors, and sodium glucose transporter inhibitors), remain scarcely analyzed in ADVHF and New York Heart Association (NYHA) Class IV. Additionally, due to the common conditions associated with advanced stages, the balance between drug tolerance and potential benefits of the contemporary use of all agents is questioned. Therefore, less hard endpoints, such as exercise tolerance, quality of life (QoL) and self-competency, are not clearly demonstrated. Specific analyses evaluating outcome and rehospitalization of each drug provided conflicting results and are often limited to subjects with stable conditions and less advanced NYHA class. Current European Society of Cardiology/American Heart Association (ESC/AHA) Guidelines do not indicate the type of treatment, dosage, and administration modalities, and they do not suggest specific indications for ADVHF patients. Due to these concerns, there is an impelling need to understand what drugs may be used as the first line, what management leads to the better outcome, and what is the best treatment algorithm in this setting. In this paper, we summarize the most common pitfalls and limitations for the use of the traditional agents, and we propose a personalized approach aiming at preserve drug tolerance and maintaining adverse event protection and satisfactory QoL.
Collapse
Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy.
| | - Gaetano Ruocco
- Cardiology Unit, "Buon Consiglio Hospital" Fatebenefratelli, Naples, Italy
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, Rome, Italy
| | - Simona Pavoncelli
- Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy
| | - Elvira Delcuratolo
- Cardiovascular Diseases Unit, Cardiothoracic and Vascular Department, Le Scotte Hospital, University of Siena, Viale Bracci 12, 53100, Siena, Italy
| | - Antonio Abbate
- Berne Cardiovascular Research Center, Division of Cardiology and Heart and Vascular Center, University of Virginia-School of Medicine, Charlottesville, VA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| |
Collapse
|
5
|
Elkan M, Kofman N, Minha S, Rappoport N, Zaidenstein R, Koren R. Does the "Obesity Paradox" Have an Expiration Date? A Retrospective Cohort Study. J Clin Med 2023; 12:6765. [PMID: 37959230 PMCID: PMC10647762 DOI: 10.3390/jcm12216765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: The "obesity paradox" refers to a protective effect of higher body mass index (BMI) on mortality in acute infectious disease patients. However, the long-term impact of this paradox remains uncertain. (2) Methods: A retrospective study of patients diagnosed with community-acquired acute infectious diseases at Shamir Medical Center, Israel (2010-2020) was conducted. Patients were grouped by BMI: underweight, normal weight, overweight, and obesity classes I-III. Short- and long-term mortality rates were compared across these groups. (3) Results: Of the 25,226 patients, diverse demographics and comorbidities were observed across BMI categories. Short-term (90-day) and long-term (one-year) mortality rates were notably higher in underweight and normal-weight groups compared to others. Specifically, 90-day mortality was 22% and 13.2% for underweight and normal weight respectively, versus 7-9% for others (p < 0.001). Multivariate time series analysis revealed underweight individuals had a significantly higher 5-year mortality risk (HR 1.41 (95% CI 1.27-1.58, p < 0.001)), while overweight and obese categories had a reduced risk (overweight-HR 0.76 (95% CI 0.72-0.80, p < 0.001), obesity class I-HR 0.71 (95% CI 0.66-0.76, p < 0.001), obesity class II-HR 0.77 (95% CI 0.70-0.85, p < 0.001), and obesity class III-HR 0.79 (95% CI 0.67-0.92, p = 0.003)). (4) Conclusions: In this comprehensive study, obesity was independently associated with decreased short- and long-term mortality. These unexpected results prompt further exploration of this counterintuitive phenomenon.
Collapse
Affiliation(s)
- Matan Elkan
- Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel (R.K.)
| | - Natalia Kofman
- Department of Cardiology, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sa’ar Minha
- Department of Cardiology, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nadav Rappoport
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Division of Government Medical Centers, Israeli Ministry of Health, Jerusalem 9101002, Israel
| | - Ronit Zaidenstein
- Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel (R.K.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ronit Koren
- Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel (R.K.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
6
|
Hathaway Q, Ibad HA, Bluemke DA, Pishgar F, Kasaiean A, Klein JG, Cogswell R, Allison M, Budoff MJ, Barr RG, Post W, Bredella MA, Lima JAC, Demehri S. Predictive Value of Deep Learning-derived CT Pectoralis Muscle and Adipose Measurements for Incident Heart Failure: Multi-Ethnic Study of Atherosclerosis. Radiol Cardiothorac Imaging 2023; 5:e230146. [PMID: 37908549 PMCID: PMC10613925 DOI: 10.1148/ryct.230146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Purpose To develop a deep learning algorithm capable of extracting pectoralis muscle and adipose measurements and to longitudinally investigate associations between these measurements and incident heart failure (HF) in participants from the Multi-Ethnic Study of Atherosclerosis (MESA). Materials and Methods MESA is a prospective study of subclinical cardiovascular disease characteristics and risk factors for progression to clinically overt disease approved by institutional review boards of six participating centers (ClinicalTrials.gov identifier: NCT00005487). All participants with adequate imaging and clinical data from the fifth examination of MESA were included in this study. Hence, in this secondary analysis, manual segmentations of 600 chest CT examinations (between the years 2010 and 2012) were used to train and validate a convolutional neural network, which subsequently extracted pectoralis muscle and adipose (intermuscular adipose tissue (IMAT), perimuscular adipose tissue (PAT), extramyocellular lipids and subcutaneous adipose tissue) area measurements from 3031 CT examinations using individualized thresholds for adipose segmentation. Next, 1781 participants without baseline HF were longitudinally investigated for associations between baseline pectoralis muscle and adipose measurements and incident HF using crude and adjusted Cox proportional hazards models. The full models were adjusted for variables in categories of demographic (age, race, sex, income), clinical/laboratory (including physical activity, BMI, and smoking), CT (coronary artery calcium score), and cardiac MRI (left ventricular ejection fraction and mass (% of predicted)) data. Results In 1781 participants (median age, 68 (IQR,61, 75) years; 907 [51%] females), 41 incident HF events occurred over a median 6.5-year follow-up. IMAT predicted incident HF in unadjusted (hazard ratio [HR]:1.14; 95% CI: 1.03-1.26) and fully adjusted (HR:1.16, 95% CI: 1.03-1.31) models. PAT also predicted incident HF in crude (HR:1.19; 95% CI: 1.06-1.35) and fully adjusted (HR:1.25; 95% CI: 1.07-1.46) models. Conclusion The study demonstrates that fast and reliable deep learning-derived pectoralis muscle and adipose measurements are obtainable from conventional chest CT, which may be predictive of incident HF.©RSNA, 2023.
Collapse
Affiliation(s)
| | | | - David A. Bluemke
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Farhad Pishgar
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Arta Kasaiean
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Joshua G. Klein
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Rebecca Cogswell
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Matthew Allison
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Matthew J. Budoff
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - R. Graham Barr
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Wendy Post
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Miriam A. Bredella
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - João A. C. Lima
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| | - Shadpour Demehri
- From the School of Medicine, West Virginia University, Morgantown, WV
(Q.H.); Russell H. Morgan Department of Radiology and Radiological Sciences
(H.A.I., F.P., A.K., J.G.K., S.D.) and Division of Cardiology, Department of
Medicine (W.P., J.A.C.L.), Johns Hopkins University School of Medicine, 601 N
Caroline St, JHOC 5165, Baltimore, MD 21287; Department of Radiology, University
of Wisconsin School of Medicine and Public Health, Madison, Wis (D.A.B.);
Department of Medicine, University of Minnesota, Minneapolis, Minn (R.C.);
Department of Family Medicine and Public Health, University of California San
Diego, La Jolla, Calif (M.A.); Lundquist Institute at Harbor-University of
California Los Angeles School of Medicine, Torrance, Calif (M.J.B.); Departments
of Medicine and Epidemiology, Columbia University Medical Center, New York, NY
(R.G.B.); and Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Boston, Mass (M.A.B.)
| |
Collapse
|
7
|
Moughrabi SM, Habib SI, Evangelista L. Depression Predicts Cardiac Cachexia in Heart Failure Patients. Biol Res Nurs 2023; 25:542-549. [PMID: 36880715 DOI: 10.1177/10998004231163186] [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: 03/08/2023]
Abstract
BACKGROUND Cardiac cachexia (CC) is associated with increased morbidity and mortality in persons with heart failure (HF). Compared to the biological underpinning of CC, little is known about the psychological factors. Thus, the overarching objective of this study was to determine whether depression predicts the onset of cachexia at 6 months in patients with chronic HF. METHODS 114 participants with a mean age of 56.7 ± 13.0 years, LVEF of 33.13 ± 12.30% and NYHA class III (48.0%) were assessed for depression using the PHQ-9. Body weight was measured at baseline and at 6 months. Patients who had ≥6% non-edematous unintentional weight loss were classified as cachectic. Univariate and logistic multivariate regression were used to examine the relationship between CC and depression, controlling for clinical and demographic variables. RESULTS Cachectic patients (11.4%) had significantly higher baseline BMI levels (31.35 ± 5.70 vs. 28.31 ± 4.73; p = .038), lower LVEF (mean = 24.50 ± 9.48 vs. 34.22 ± 12.18, p = .009), and depression scores (mean = 7.17 ± 6.44 vs. 4.27 ± 3.98, p = .049) when compared to their non-cachectic counterparts. In multivariate regression analysis, depression scores (β = 1.193, p = .035) and LVEF (β = .835, p = .031) predicted cachexia after controlling for age, gender, body mass index, VO2 max, and New York Heart Association class and accounted for 49% of the variance in Cardiac cachexia. When depression was dichotomized, depression and LVEF predicted 52.6% of the variance in CC. CONCLUSION Depression predicts CC in patients with HF. Additional studies are needed to expand the knowledge of the role of the psychological determinants of this devastating syndrome.
Collapse
Affiliation(s)
- Samira M Moughrabi
- Associate Professor, California State University-Dominguez Hills, Carson, CA, USA
| | - Samer I Habib
- Specialist in Poison Information, University of Texas, Southwestern and Parkland Hospital, Dallas, TX, USA
| | | |
Collapse
|
8
|
Ahmadi Hekmatikar A, Nelson A, Petersen A. Highlighting the idea of exerkines in the management of cancer patients with cachexia: novel insights and a critical review. BMC Cancer 2023; 23:889. [PMID: 37730552 PMCID: PMC10512651 DOI: 10.1186/s12885-023-11391-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Exerkines are all peptides, metabolites, and nucleic acids released into the bloodstream during and after physical exercise. Exerkines liberated from skeletal muscle (myokines), the heart (cardiokines), liver (hepatokines), white adipose tissue (adipokines), brown adipose tissue (batokines), and neurons (neurokines) may benefit health and wellbeing. Cancer-related cachexia is a highly prevalent disorder characterized by weight loss with specific skeletal muscle and adipose tissue loss. Many studies have sought to provide exercise strategies for managing cachexia, focusing on musculoskeletal tissue changes. Therefore, understanding the responses of musculoskeletal and other tissue exerkines to acute and chronic exercise may provide novel insight and recommendations for physical training to counteract cancer-related cachexia. METHODS For the purpose of conducting this study review, we made efforts to gather relevant studies and thoroughly discuss them to create a comprehensive overview. To achieve this, we conducted searches using appropriate keywords in various databases. Studies that were deemed irrelevant to the current research, not available in English, or lacking full-text access were excluded. Nevertheless, it is important to acknowledge the limited amount of research conducted in this specific field. RESULTS In order to obtain a comprehensive understanding of the findings, we prioritized human studies in order to obtain results that closely align with the scope of the present study. However, in instances where human studies were limited or additional analysis was required to draw more robust conclusions, we also incorporated animal studies. Finally, 295 studies, discussed in this review. CONCLUSION Our understanding of the underlying physiological mechanisms related to the significance of investigating exerkines in cancer cachexia is currently quite basic. Nonetheless, this demonstrated that resistance and aerobic exercise can contribute to the reduction and control of the disease in individuals with cancer cachexia, as well as in survivors, by inducing changes in exerkines.
Collapse
Affiliation(s)
- Amirhossein Ahmadi Hekmatikar
- Department of Physical Education & Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, 14117-13116, Iran
| | - André Nelson
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Aaron Petersen
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
| |
Collapse
|
9
|
Kubat GB, Bouhamida E, Ulger O, Turkel I, Pedriali G, Ramaccini D, Ekinci O, Ozerklig B, Atalay O, Patergnani S, Nur Sahin B, Morciano G, Tuncer M, Tremoli E, Pinton P. Mitochondrial dysfunction and skeletal muscle atrophy: Causes, mechanisms, and treatment strategies. Mitochondrion 2023; 72:33-58. [PMID: 37451353 DOI: 10.1016/j.mito.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Skeletal muscle, which accounts for approximately 40% of total body weight, is one of the most dynamic and plastic tissues in the human body and plays a vital role in movement, posture and force production. More than just a component of the locomotor system, skeletal muscle functions as an endocrine organ capable of producing and secreting hundreds of bioactive molecules. Therefore, maintaining healthy skeletal muscles is crucial for supporting overall body health. Various pathological conditions, such as prolonged immobilization, cachexia, aging, drug-induced toxicity, and cardiovascular diseases (CVDs), can disrupt the balance between muscle protein synthesis and degradation, leading to skeletal muscle atrophy. Mitochondrial dysfunction is a major contributing mechanism to skeletal muscle atrophy, as it plays crucial roles in various biological processes, including energy production, metabolic flexibility, maintenance of redox homeostasis, and regulation of apoptosis. In this review, we critically examine recent knowledge regarding the causes of muscle atrophy (disuse, cachexia, aging, etc.) and its contribution to CVDs. Additionally, we highlight the mitochondrial signaling pathways involvement to skeletal muscle atrophy, such as the ubiquitin-proteasome system, autophagy and mitophagy, mitochondrial fission-fusion, and mitochondrial biogenesis. Furthermore, we discuss current strategies, including exercise, mitochondria-targeted antioxidants, in vivo transfection of PGC-1α, and the potential use of mitochondrial transplantation as a possible therapeutic approach.
Collapse
Affiliation(s)
- Gokhan Burcin Kubat
- Department of Mitochondria and Cellular Research, Gulhane Health Sciences Institute, University of Health Sciences, 06010 Ankara, Turkey.
| | - Esmaa Bouhamida
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy
| | - Oner Ulger
- Department of Mitochondria and Cellular Research, Gulhane Health Sciences Institute, University of Health Sciences, 06010 Ankara, Turkey
| | - Ibrahim Turkel
- Department of Exercise and Sport Sciences, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey
| | - Gaia Pedriali
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy
| | - Daniela Ramaccini
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy
| | - Ozgur Ekinci
- Department of Pathology, Gazi University, 06500 Ankara, Turkey
| | - Berkay Ozerklig
- Department of Exercise and Sport Sciences, Faculty of Sport Sciences, Hacettepe University, 06800 Ankara, Turkey
| | - Ozbeyen Atalay
- Department of Physiology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Simone Patergnani
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy; Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy
| | - Beyza Nur Sahin
- Department of Physiology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Giampaolo Morciano
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy; Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy
| | - Meltem Tuncer
- Department of Physiology, Faculty of Medicine, Hacettepe University, 06230 Ankara, Turkey
| | - Elena Tremoli
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy
| | - Paolo Pinton
- Translational Research Center, Maria Cecilia Hospital GVM Care & Research, 48033 Cotignola, Italy; Department of Medical Sciences, Laboratory for Technologies of Advanced Therapies (LTTA), University of Ferrara, 44121 Ferrara, Italy.
| |
Collapse
|
10
|
Fujimoto Y, Maeda D, Kagiyama N, Sunayama T, Dotare T, Jujo K, Saito K, Kamiya K, Saito H, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Wada H, Hiki M, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Wakaume K, Oka K, Momomura SI, Matsue Y. Prevalence and prognostic impact of the coexistence of cachexia and sarcopenia in older patients with heart failure. Int J Cardiol 2023; 381:45-51. [PMID: 36934990 DOI: 10.1016/j.ijcard.2023.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND No study with an adequate patients' number has examined the relationship/overlap between sarcopenia and cachexia. We examined the prevalence of the overlap and prognostic implications of sarcopenia and cachexia in older patients with heart failure using well-accepted definitions. METHODS This was a post-hoc sub-analysis of the FRAGILE-HF study, a prospective, multicenter, observational study conducted at 15 hospitals in Japan. In total, 905 hospitalized older patients were classified into four groups based on the presence or absence of cachexia and/or sarcopenia, which were defined according to the Evans and Asian Working Group for Sarcopenia criteria revised in 2019, respectively. The primary endpoint was 2-year all-cause mortality. RESULTS Cachexia and sarcopenia prevalence rates were 32.7% and 22.7%, respectively. Patients were classified into the non-cachexia/non-sarcopenia (55.7%), cachexia/non-sarcopenia (21.7%), non-cachexia/sarcopenia (11.6%), and cachexia/sarcopenia (11.0%) groups. During the 2-year follow-up period after discharge, 158 (17.5%) all-cause deaths (124 cardiovascular deaths [CVD] and 34 non-CVD) were observed. The cachexia/sarcopenia group had the lowest body fat mass and exhibited significantly higher mortality rates (log-rank P < 0.001). Cox proportional hazard analysis revealed that cachexia/sarcopenia was an independent prognostic factor after adjusting for known prognostic factors (versus non-cachexia/non-sarcopenia: hazard ratio, 2.78; 95% confidence interval, 1.80-4.29; P < 0.001). Neither cachexia/non-sarcopenia nor non-cachexia/sarcopenia were significantly associated with all-cause mortality compared with non-cachexia/non-sarcopenia. CONCLUSIONS Cachexia and sarcopenia are prevalent among older hospitalized patients with heart failure; nonetheless, the overlap is not as prominent as previously expected. The presence of cachexia and sarcopenia is a risk factor for all-cause mortality.
Collapse
Affiliation(s)
- Yudai Fujimoto
- Department of Cardiovascular Medicine, Saitama Medical Centre, Jichi Medical University, Saitama, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Centre Hospital, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroshi Saito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Rehabilitation, Kameda Medical Centre, Kamogawa, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Centre, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka, Japan; Department of Rehabilitation, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Centre General Hospital, Kobe, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Centre, Jichi Medical University, Saitama, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Matsui Heart Clinic, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Kazuki Wakaume
- Rehabilitation Centre, Kitasato University Medical Centre, Tokyo, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Centre, Saitama, Japan
| | | | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| |
Collapse
|
11
|
Cuthbert JJ, Pellicori P, Rigby AS, Abel AAI, Kalvickbacka-Bennet A, Shah P, Kearsley JW, Kazmi S, Cleland JGF, Clark AL. Are non-invasive estimations of plasma volume an accurate measure of congestion in patients with chronic heart failure? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:281-292. [PMID: 35723241 DOI: 10.1093/ehjqcco/qcac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 05/17/2023]
Abstract
AIMS We report associations between different formulae for estimating plasma volume status (PVS) and clinical and ultrasound markers of congestion in patients with chronic heart failure (CHF) enrolled in the Hull Lifelab registry. METHODS AND RESULTS Cohort 1 comprised patients with data on signs and symptoms at initial evaluation (n = 3505). Cohort 2 included patients with ultrasound assessment of congestion [lung B-line count, inferior vena cava (IVC) diameter, jugular vein distensibility (JVD) ratio] (N = 341). Two formulae for PVS were used: (a) Hakim (HPVS) and (b) Duarte (DPVS). Results were compared with clinical and ultrasound markers of congestion. Outcomes assessed were mortality and the composite of heart failure (HF) hospitalisation and all-cause mortality. In cohort 1, HPVS was associated with mortality [hazard ratio (HR) per unitary increase = 1.02 (1.01-1.03); P < 0.001]. In cohort 2, HPVS was associated with B-line count (HR) = 1.05 [95% confidence interval (CI) (1.01-1.08); P = 0.02] and DPVS with the composite outcome [HR = 1.26 (1.01-1.58); P = 0.04]. HPVS and DPVS were strongly related to haemoglobin concentration and HPVS to weight. After multivariable analysis, there were no strong or consistent associations between PVS and measures of congestion, severity of symptoms, or outcome. By contrast, log[NTproBNP] was strongly associated with all three. CONCLUSION Amongst patients with CHF, HPVS and DPVS are not strongly or consistently associated with clinical or ultrasound evidence of congestion, nor clinical outcomes after multivariable adjustment. They appear only to be surrogates of the variables from which they are calculated with no intrinsic clinical utility.
Collapse
Affiliation(s)
- J J Cuthbert
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A S Rigby
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - A A I Abel
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| | - A Kalvickbacka-Bennet
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - P Shah
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J W Kearsley
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - S Kazmi
- Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU6 7RX
| | - J G F Cleland
- Robertson Centre for Biostatistics, Glasgow Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A L Clark
- Department of Cardiology, Hull University Hospitals Trust, Castle Hill Hospital, Castle Road, Cottingham, Kingston-Upon-Hull, East Riding of Yorkshire, UK, HU16 5JQ
| |
Collapse
|
12
|
Koppe L, Mak RH. Is There a Need to "Modernize" and "Simplify" the Diagnostic Criteria of Protein-Energy Wasting? Semin Nephrol 2023; 43:151403. [PMID: 37541069 DOI: 10.1016/j.semnephrol.2023.151403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Protein energy wasting(PEW) is a term that most nephrologists used to define nutritional disorders in patients with acute kidney injury and chronic kidney disease. Although this nomenclature is well implemented in the field of nephrology, the use of other terms such as cachexia or malnutritionin the majority of chronic diseases can induce confusion regarding the definition and interpretation of these terms. There is ample evidence in the literature that the pathways involved in cachexia/malnutrition and PEW are common. However, in kidney diseases, there are pathophysiological conditions such as accumulation of uremic toxins, and the use of dialysis, which may induce a phenotypic specificity justifying the original term PEW. In light of the latest epidemiologic studies, the criteria for PEW used in 2008 probably need to be updated. The objective of this review is to summarize the main mechanisms involved in cachexia/malnutrition and PEW. We discuss the need to modernize and simplify the current definition and diagnostic criteria of PEW. We consider the interest of proposing a specific nomenclature of PEW for children and elderly patients with kidney diseases.
Collapse
Affiliation(s)
- Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, Cardiovasculaire, Métabolisme, Diabète et Nutrition Laboratory, Institut National des Sciences Appliquées-Lyon, Institut National de la Santé et de la Recherche Médicale U1060, l'Institut National de Recherche Pour l'agriculture, l'alimentation et l'environnement (INRAE), Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California San Diego, La Jolla, California
| |
Collapse
|
13
|
Ma D, Wu T, Qu Y, Yang J, Cai L, Li X, Wang Y. Astragalus polysaccharide prevents heart failure-induced cachexia by alleviating excessive adipose expenditure in white and brown adipose tissue. Lipids Health Dis 2023; 22:9. [PMID: 36670439 PMCID: PMC9863193 DOI: 10.1186/s12944-022-01770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Astragalus polysaccharide (APS) is a key active ingredient isolated from Astragalus membranaceus that has been reported to be a potential treatment for obesity and diabetes by regulating lipid metabolism and adipogenesis, alleviating inflammation, and improving insulin resistance. However, whether APS regulates lipid metabolism in the context of cachexia remains unclear. Therefore, this study analysed the effects of APS on lipid metabolism and adipose expenditure in a heart failure (HF)-induced cardiac cachexia rat model. METHODS: A salt-sensitive hypertension-induced cardiac cachexia rat model was used in the present study. Cardiac function was detected by echocardiography. The histological features and fat droplets in fat tissue and liver were observed by H&E staining and Oil O Red staining. Immunohistochemical staining, Western blotting and RT‒qPCR were used to detect markers of lipolysis and adipose browning in white adipose tissue (WAT) and thermogenesis in brown adipose tissue (BAT). Additionally, sympathetic nerve activity and inflammation in adipose tissue were detected. RESULTS Rats with HF exhibited decreased cardiac function and reduced adipose accumulation as well as adipocyte atrophy. In contrast, administration of APS not only improved cardiac function and increased adipose weight but also prevented adipose atrophy and FFA efflux in HF-induced cachexia. Moreover, APS inhibited HF-induced lipolysis and browning of white adipocytes since the expression levels of lipid droplet enzymes, including HSL and perilipin, and beige adipocyte markers, including UCP-1, Cd137 and Zic-1, were suppressed after administration of APS. In BAT, treatment with APS inhibited PKA-p38 MAPK signalling, and these effects were accompanied by decreased thermogenesis reflected by decreased expression of UCP-1, PPAR-γ and PGC-1α and reduced FFA β-oxidation in mitochondria reflected by decreased Cd36, Fatp-1 and Cpt1. Moreover, sympathetic nerve activity and interleukin-6 levels were abnormally elevated in HF rats, and astragalus polysaccharide could inhibit their activity. CONCLUSION APS prevented lipolysis and adipose browning in WAT and decreased BAT thermogenesis. These effects may be related to suppressed sympathetic activity and inflammation. This study provides a potential approach to treat HF-induced cardiac cachexia.
Collapse
Affiliation(s)
- Dufang Ma
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, 250014, Jinan, China
| | - Tao Wu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yiwei Qu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jinlong Yang
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, 250014, Jinan, China
| | - Lu Cai
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, 250014, Jinan, China
| | - Xiao Li
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, 250014, Jinan, China
| | - Yong Wang
- Department of Cardiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Shandong, 250014, Jinan, China.
| |
Collapse
|
14
|
Drapkina OM, Skripnikova IA, Yaralieva EK, Myasnikov RP. Body composition in patients with heart failure. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The redistribution of body composition components in heart failure (CHF) is an urgent and poorly understood issue. Despite the significant impact of a decrease in muscle mass, redistribution of fat mass on the course and prognosis of HF, body composition is rarely taken into account in the treatment of this disease. In this regard, the purpose of this review was to systematize the available data and draw the attention of clinicians to this problem. The data presented in the review make it possible to consider the components of body composition as controllable factors, the normalization of which improves the prognosis in patients with HF. The study of pathophysiological mechanisms for the development of body composition anomalies in HF will make it possible to search for new therapeutic targets. Assessment of body composition will make it possible to develop an individual strategy for the treatment of HF, including a set of non-drug measures.
Collapse
Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - I. A. Skripnikova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. K. Yaralieva
- National Medical Research Center for Therapy and Preventive Medicine
| | - R. P. Myasnikov
- National Medical Research Center for Therapy and Preventive Medicine
| |
Collapse
|
15
|
Evertz R, Gödde K, Diehl C, Valentova M, Garfias‐Veitl T, Braulke F, Wulf GG, Overbeck TR, Bleckmann A, König AO, Weinländer P, Potthoff S, Hadzibegovic S, Lena A, Keller U, Landmesser U, Schuster A, Anker MS, Hasenfuß G, von Haehling S. Cardiovascular and metabolic determinants of quality of life in patients with cancer. ESC Heart Fail 2022; 10:167-176. [PMID: 36178215 PMCID: PMC9871717 DOI: 10.1002/ehf2.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Maintaining quality of life (QoL) in patients with cancer has gathered significant interest, but little is known about its major determinants. We sought to identify determinants of QoL in patients undergoing cancer treatment as well as in treatment-naïve patients about to commence such therapy. METHODS AND RESULTS QoL was assessed in 283 patients with cancer using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 questionnaire. All patients underwent a battery of tests including physical examination, resting electrocardiogram, hand grip strength, and biochemistry assessment. Using multivariable logistic regression, we found that age [odds ratio (OR) 0.954, 95% confidence interval (CI) 0.916-0.994], resting heart rate (OR 1.036, 95% CI 1.004-1.068), hand grip strength (OR 0.932, 95% CI 0.878-0.990), and the presence of cachexia (OR 4.334, 95% CI 1.767-10.631) and dyspnoea (OR 3.725, 95% CI 1.540-9.010; all P < 0.05) remained independently predictive of reduced QoL. CONCLUSIONS Therefore, it may be reasonable to address circumstances that are affecting muscle mass, body weight, and heart rate to maintaining QoL; however, prospective studies to test these endpoints are required.
Collapse
Affiliation(s)
- Ruben Evertz
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Katharina Gödde
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Christine Diehl
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,Department of PaediatricsUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Miroslava Valentova
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Tania Garfias‐Veitl
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Friederike Braulke
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,Comprehensive Cancer Center G‐CCCUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Gerald G. Wulf
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Tobias R. Overbeck
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Annalen Bleckmann
- Department of Haematology and Medical OncologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,Department of Medicine, Hematology, Oncology, and PneumologyUniversity Hospital MünsterMünsterGermany,West German Cancer CenterUniversity Hospital MünsterMünsterGermany
| | - Alexander O. König
- Department of GastroenterologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany
| | - Pia Weinländer
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité University Medicine BerlinBerlinGermany
| | - Sophia Potthoff
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité University Medicine BerlinBerlinGermany
| | - Sara Hadzibegovic
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
| | - Alessia Lena
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité University Medicine BerlinBerlinGermany
| | - Ulrich Keller
- Department of Hematology, Oncology and Cancer ImmunologyCharité – Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinGermany,Max‐Delbrück‐Center for Molecular MedicineBerlinGermany,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Ulf Landmesser
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Berlin Institute of Health (BIH)BerlinGermany
| | - Andreas Schuster
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Markus S. Anker
- Department of CardiologyCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF)BerlinGermany,German Center for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany,Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical Center (UMG)GöttingenGermany,German Center for Cardiovascular Research (DZHK), partner site Göttingen37075GöttingenGermany
| |
Collapse
|
16
|
Abstract
Cachexia is a complex wasting syndrome, accompanying a variety of end-stage chronic diseases, such as cancer, heart failure and human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). It significantly affects patients' quality of life and survival. Multiple therapeutic approaches have been studied over time. However, despite promising results, no drug has been approved to date. In this review, we examine and discuss the available data on the therapeutic effects of androgens and selective androgen receptor modulators (SARMs) for cachexia.
Collapse
Affiliation(s)
- Luca Giovanelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100, Milan, Italy; Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100, Milan, Italy; Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals, NE1 4LP, UK.
| | - Richard Quinton
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals, NE1 4LP, UK; Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, NE1 3BZ, UK.
| |
Collapse
|
17
|
Carson MA, Reid J, Hill L, Dixon L, Donnelly P, Slater P, Hill A, Piper SE, McDonagh TA, Fitzsimons D. Exploring the prevalence, impact and experience of cardiac cachexia in patients with advanced heart failure and their caregivers: A sequential phased study. Palliat Med 2022; 36:1118-1128. [PMID: 35729767 PMCID: PMC9248000 DOI: 10.1177/02692163221101748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cardiac Cachexia is a wasting syndrome that has a significant impact on patient mortality and quality of life world-wide, although it is poorly understood in clinical practice. AIM Identify the prevalence of cardiac cachexia in patients with advanced New York Heart Association (NYHA) functional class and explore its impact on patients and caregivers. DESIGN An exploratory cross-sectional study. The sequential approach had two phases, with phase 1 including 200 patients with NYHA III-IV heart failure assessed for characteristics of cardiac cachexia. Phase 2 focussed on semi-structured interviews with eight cachectic patients and five caregivers to ascertain the impact of the syndrome. SETTING/PARTICIPANTS Two healthcare trusts within the United Kingdom. RESULTS Cardiac Cachexia was identified in 30 out of 200 participants, giving a prevalence rate of 15%. People with cachexia had a significantly reduced average weight and anthropometric measures (p < 0.05). Furthermore, individuals with cachexia experienced significantly more fatigue, had greater issues with diet and appetite, reduced physical wellbeing and overall reduced quality of life. C-reactive protein was significantly increased, whilst albumin and red blood cell count were significantly decreased in the cachectic group (p < 0.05). From qualitative data, four key themes were identified: (1) 'Changed relationship with food and eating', (2) 'Not me in the mirror', (3) 'Lack of understanding regarding cachexia' and (4) 'Uncertainty regarding the future'. CONCLUSIONS Cardiac cachexia has a debilitating effect on patients and caregivers. Future work should focus on establishing a specific definition and clinical pathway to enhance patient and caregiver support.
Collapse
Affiliation(s)
- Matthew A Carson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Lana Dixon
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Patrick Donnelly
- Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, UK
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Alyson Hill
- Nutrition Innovation Centre for Food and Health, Ulster University, Belfast, UK
| | - Susan E Piper
- Department of Cardiovascular Research, King's College London, James Black Centre, London, UK.,Kings College Hospital NHS Foundation Trust, London, UK
| | - Theresa A McDonagh
- Department of Cardiovascular Research, King's College London, James Black Centre, London, UK.,Kings College Hospital NHS Foundation Trust, London, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| |
Collapse
|
18
|
Israr MZ, Zhan H, Salzano A, Voors AA, Cleland JG, Anker SD, Metra M, van Veldhuisen DJ, Lang CC, Zannad F, Samani NJ, Ng LL, Suzuki T. Surrogate markers of gut dysfunction are related to heart failure severity and outcome-from the BIOSTAT-CHF consortium. Am Heart J 2022; 248:108-119. [PMID: 35278373 DOI: 10.1016/j.ahj.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The contribution of gut dysfunction to heart failure (HF) pathophysiology is not routinely assessed. We sought to investigate whether biomarkers of gut dysfunction would be useful in assessment of HF (eg, severity, adverse outcomes) and risk stratification. METHODS A panel of gut-related biomarkers including metabolites of the choline/carnitine- pathway (acetyl-L-carnitine, betaine, choline, γ-butyrobetaine, L-carnitine and trimethylamine-N-oxide [TMAO]) and the gut peptide, Trefoil factor-3 (TFF-3), were investigated in 1,783 patients with worsening HF enrolled in the systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) cohort and associations with HF severity and outcomes, and use in risk stratification were assessed. RESULTS Metabolites of the carnitine-TMAO pathway (acetyl-L-carnitine, γ-butyrobetaine, L-carnitine, and TMAO) and TFF-3 were associated with the composite outcome of HF hospitalization or all-cause mortality at 3 years (hazards ratio [HR] 2.04-2.93 [95% confidence interval {CI} 1.30-4.71] P≤ .002). Combining the carnitine-TMAO metabolites with TFF-3, as a gut dysfunction panel, showed a graded association; a greater number of elevated markers was associated with higher New York Heart Association class (P< .001), higher plasma concentrations of B-type natriuretic peptide (P< .001), and worse outcome (HR 1.90-4.58 [95% CI 1.19-6.74] P≤ 0.008). Addition of gut dysfunction biomarkers to the contemporary BIOSTAT HF risk model also improved prediction for the aforementioned composite outcome (C-statistics P≤ .011, NRI 13.5-21.1 [95% CI 2.7-31.9] P≤ .014). CONCLUSIONS A panel of biomarkers of gut dysfunction showed graded association with severity of HF and adverse outcomes. Biomarkers as surrogate markers are potentially useful for assessment of gut dysfunction to HF pathophysiology and in risk stratification.
Collapse
Affiliation(s)
- Muhammad Zubair Israr
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Hong Zhan
- Tellgen Corporation, Shanghai, China
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John G Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow and National Heart and Lung Institute, Imperial College, London, UK
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Metra
- Department of Medical and Surgical Specialties, Institute of Cardiology, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Chim C Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Faiez Zannad
- Inserm CIC 1433, Université de Lorraine, CHU de Nancy, Nancy, France
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK; The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | | |
Collapse
|
19
|
Watanabe Y, Horiuchi Y, Nakase M, Setoguchi N, Ishizawa T, Sekiguchi M, Nonaka H, Nakajima M, Asami M, Yahagi K, Komiyama K, Yuzawa H, Tanaka J, Aoki J, Tanabe K. Malnutrition, hemodynamics and inflammation in heart failure with reduced, mildly reduced and preserved ejection fraction. Heart Vessels 2022; 37:1841-1849. [PMID: 35588322 DOI: 10.1007/s00380-022-02090-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
In patients with heart failure (HF) with reduced ejection fraction (HFrEF), malnutrition can be associated with intestinal congestion and systemic inflammation. These relationships have not been fully investigated in HF with mildly reduced EF (HFmrEF) and with preserved EF (HFpEF). We analyzed 420 patients with HF who underwent right heart catheterization. The relationships between hemodynamic parameters, C-reactive protein, and the controlling nutritional (CONUT) score were investigated in HFrEF, HFmrEF and HFpEF. The CONUT score of all patients was 2 [1, 4] (median [interquartile range]), and was not significantly different between the left ventricular EF (LVEF) categories (2 [1, 3] for HFrEF, 2 [1, 3] for HFmrEF, and 3 [1, 4] for HFpEF, p = 0.279). In multivariate linear regression analyses, there was a significant association between CRP and the CONUT score in HFmrEF and HFpEF, while brain natriuretic peptide and right atrial pressure were significantly associated with the CONUT score in HFrEF. Higher CONUT scores predicted a higher incidence of the composite endpoint of death or HF hospitalization within 12 months without an interaction with LVEF (p = 0.980). The CONUT score was an independent predictor of the composite endpoint, death, and HF hospitalization after adjustment for confounders in the multivariate analysis. In conclusion, inflammation was associated with malnutrition in HFmrEF and HFpEF, while congestion was an independent predictor of malnutrition in HFrEF. Malnutrition predicted worse outcomes regardless of LVEF.
Collapse
Affiliation(s)
- Yusuke Watanabe
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Masaaki Nakase
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Naoto Setoguchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Taiki Ishizawa
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Masahiro Sekiguchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Hideaki Nonaka
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Momoka Nakajima
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kota Komiyama
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Hitomi Yuzawa
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Jun Tanaka
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Jiro Aoki
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| |
Collapse
|
20
|
Kleissl-Muir S, Rasmussen B, Owen A, Zinn C, Driscoll A. Low Carbohydrate Diets for Diabetic Cardiomyopathy: A Hypothesis. Front Nutr 2022; 9:865489. [PMID: 35529461 PMCID: PMC9069235 DOI: 10.3389/fnut.2022.865489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Elevated blood glucose levels, insulin resistance (IR), hyperinsulinemia and dyslipidemia the key aspects of type 2 diabetes mellitus (T2DM), contribute to the development of a certain form of cardiomyopathy. This cardiomyopathy, also known as diabetic cardiomyopathy (DMCM), typically occurs in the absence of overt coronary artery disease (CAD), hypertension or valvular disease. DMCM encompasses a variety of pathophysiological processes impacting the myocardium, hence increasing the risk for heart failure (HF) and significantly worsening outcomes in this population. Low fat (LF), calorie-restricted diets have been suggested as the preferred eating pattern for patients with HF. However, LF diets are naturally higher in carbohydrates (CHO). We argue that in an insulin resistant state, such as in DMCM, LF diets may worsen glycaemic control and promote further insulin resistance (IR), contributing to a physiological and functional decline in DMCM. We postulate that CHO restriction targeting hyperinsulinemia may be able to improve tissue and systemic IR. In recent years low carbohydrate diets (LC) including ketogenic diets (KD), have emerged as a safe and effective tool for the management of various clinical conditions such as T2DM and other metabolic disorders. CHO restriction achieves sustained glycaemic control, lower insulin levels and successfully reverses IR. In addition to this, its pleiotropic effects may present a metabolic stress defense and facilitate improvement to cardiac function in patients with HF. We therefore hypothesize that patients who adopt a LC diet may require less medications and experience improvements in HF-related symptom burden.
Collapse
Affiliation(s)
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- The Centre for Quality and Patient Safety, Institute of Health Transformation -Western Health Partnership, Western Health, St Albans, VIC, Australia
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Centre, Odense, Denmark
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caryn Zinn
- Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Cardiology, Austin Health, Heidelberg, VIC, Australia
| |
Collapse
|
21
|
Cardio-onco-metabolism: metabolic remodelling in cardiovascular disease and cancer. Nat Rev Cardiol 2022; 19:414-425. [PMID: 35440740 PMCID: PMC10112835 DOI: 10.1038/s41569-022-00698-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease and cancer are the two leading causes of morbidity and mortality in the world. The emerging field of cardio-oncology has revealed that these seemingly disparate disease processes are intertwined, owing to the cardiovascular sequelae of anticancer therapies, shared risk factors that predispose individuals to both cardiovascular disease and cancer, as well the possible potentiation of cancer growth by cardiac dysfunction. As a result, interest has increased in understanding the fundamental biological mechanisms that are central to the relationship between cardiovascular disease and cancer. Metabolism, appropriate regulation of energy, energy substrate utilization, and macromolecular synthesis and breakdown are fundamental processes for cellular and organismal survival. In this Review, we explore the emerging data identifying metabolic dysregulation as an important theme in cardio-oncology. We discuss the growing recognition of metabolic reprogramming in cardiovascular disease and cancer and view the novel area of cardio-oncology through the lens of metabolism.
Collapse
|
22
|
Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, González-Navarro I, Remón-Ruíz PJ, Pereira-Cunill JL, García-Luna PP. Perioperative Nutritional Support: A Review of Current Literature. Nutrients 2022; 14:nu14081601. [PMID: 35458163 PMCID: PMC9030898 DOI: 10.3390/nu14081601] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/27/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
Since the beginning of the practice of surgery, the reduction of postoperative complications and early recovery have been two of the fundamental pillars that have driven the improvement of surgical techniques and perioperative management. Despite great advances in these fields, the rationalization of antibiotic prophylaxis, and other important innovations, postoperative recovery (especially in elderly patients, oncological pathology or digestive or head and neck surgery) is tortuous. This can be explained by several reasons, among which, malnutrition has a major role. Perioperative nutritional support, included within the ERAS (Enhanced Recovery After Surgery) protocol, has proven to be a main element and a critical step to achieve better surgical results. Starting with the preoperative nutritional assessment and treatment in elective surgery, we can improve nutritional status using oral supplements and immunomodulatory formulas. If we add early nutritional support in the postoperative scenario, we are able to significantly reduce infectious complications, need for intensive care unit (ICU) and hospital stay, costs, and mortality. Throughout this review, we will review the latest developments and the available literature.
Collapse
|
23
|
Ni HJ, Hsu TF, Chen LK, Chou HL, Tung HH, Chow LH, Chen YC. Effects of Exercise Programs in older adults with Muscle Wasting: A Systematic Review and Meta-analysis. Arch Gerontol Geriatr 2022; 99:104605. [DOI: 10.1016/j.archger.2021.104605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
|
24
|
Cardiac Complications: The Understudied Aspect of Cancer Cachexia. Cardiovasc Toxicol 2022; 22:254-267. [PMID: 35171467 DOI: 10.1007/s12012-022-09727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/03/2022] [Indexed: 12/17/2022]
Abstract
The global burden of cancer cachexia is increasing along with drastic increase in cancer patients. Cancer itself leads to cachexia, and cachexia development is associated with events like altered hemodynamics, and reduced functional capacity of the heart among others which lead to failure of the heart and are called cardiovascular complications associated with cancer cachexia. In some patients, the anti-cancer therapy also leads to this cardiovascular complications. So, in this review, an attempt is made to understand the mechanisms, pathophysiology of cardiovascular events in cachectic patients. Important processes which cause cardiovascular complications include alterations in the structure of the heart, loss of cardiac mass and functioning, cardiac fibrosis and cardiac remodeling, apoptosis, cardiac muscle atrophy, and mitochondrial alterations. Previously, the available treatment options were limited to nutraceuticals and physical exercise. Recently, studies with some prospective agents that can improve cardiac health have been reported, but whether their action is effective in cardiovascular complications associated with cancer cachexia is not known or are under trial.
Collapse
|
25
|
Bordignon C, dos Santos BS, Rosa DD. Impact of Cancer Cachexia on Cardiac and Skeletal Muscle: Role of Exercise Training. Cancers (Basel) 2022; 14:cancers14020342. [PMID: 35053505 PMCID: PMC8773522 DOI: 10.3390/cancers14020342] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Cachexia is a syndrome that can be present in many patients diagnosed with cancer, especially in those with metastatic or very advanced tumors. The patient may present with weight loss, loss of muscle mass, and even cardiac dysfunction as a result of it. The aim of this review is to understand how cachexia manifests and whether physical exercise has any role in trying to prevent or reverse this syndrome in cancer patients. Abstract Cachexia is a multifactorial syndrome that presents with, among other characteristics, progressive loss of muscle mass and anti-cardiac remodeling effect that may lead to heart failure. This condition affects about 80% of patients with advanced cancer and contributes to worsening patients’ tolerance to anticancer treatments and to their premature death. Its pathogenesis involves an imbalance in metabolic homeostasis, with increased catabolism and inflammatory cytokines levels, leading to proteolysis and lipolysis, with insufficient food intake. A multimodal approach is indicated for patients with cachexia, with the aim of reducing the speed of muscle wasting and improving their quality of life, which may include nutritional, physical, pharmacologic, and psychological support. This review aims to outline the mechanisms of muscle loss, as well as to evaluate the current clinical evidence of the use of physical exercise in patients with cachexia.
Collapse
Affiliation(s)
- Cláudia Bordignon
- Oncology Center, Hospital Moinhos de Vento, Porto Alegre 90560-030, Brazil;
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-070, Brazil
| | - Bethânia S. dos Santos
- Department of Clinical Research, Brazilian National Cancer Institute (INCA), Rio de Janeiro 20560-121, Brazil;
- Rede D’Or São Luiz, Rio de Janeiro 22271-110, Brazil
| | - Daniela D. Rosa
- Oncology Center, Hospital Moinhos de Vento, Porto Alegre 90560-030, Brazil;
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-070, Brazil
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre 90619-900, Brazil
- Correspondence:
| |
Collapse
|
26
|
COŞGUN MS, ÇOŞKUN R, CELIK AI. The preventive effect of taxifolin on acrylamide-induced heart damage in rats. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ABSTRACT Objective Acrylamide is a toxic compound widely used in industrial sectors. Acrylamide causes reactive oxygen species formation and the subsequent lipid peroxidation reaction, which plays an important role in the pathogenesis of oxidative damage. Taxifolin is a flavonoid with antioxidant properties that inhibit reactive oxygen species formation. In this study, we aimed to investigate the preventive effect of taxifolin on acrylamide-induced oxidative heart damage. Methods The rats were divided into three groups: Acrylamide, Acrylamide+Taxifolin , and Healthy group. Water and food intake and body weight alterations were recorded daily. Malondialdehyde, total glutathione, nuclear factor kappa-B, total oxidant status, and total antioxidant status levels were analyzed from the heart tissue. Troponin-I levels, the parameter known as a cardiac biomarker, were analyzed from the blood sample. The cardiac histopathologic examination was also performed. Results In the Acrylamide group animals, the malondialdehyde, nuclear factor kappa-B, total oxidant status, and troponin-I levels were significantly higher compared to the ones of Acrylamide+Taxifolin and Healthy groups. The levels of total glutathione and total antioxidant status were significantly lower compared to Acrylamide+Taxifolin and Healthy groups’. Additionally, in the Acrylamide group, body weight gain, food and water intake, significantly declined compared to the Acrylamide+Taxifolin and Healthy groups. However, in the Acrylamide+Taxifolin group, taxifolin supplementation brought these values close to Healthy group ones. Furthermore, taxifolin treatment ameliorated structural myocardial damage signs induced by acrylamide. Conclusion Acrylamide exposure significantly induced oxidative damage to rat heart tissue. Taxifolin was able to improve the toxic consequences of acrylamide biochemically and histopathologically, possibly due to its antioxidant properties.
Collapse
|
27
|
Kiuchi K, Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Nishigoori S, Sawatani T, Otsuka Y, Kokubun H, Miyakuni T, Kobayashi N, Asai K, Shimizu W. The Prognostic Impact of Hospital Transfer after Admission due to Acute Heart Failure. Int Heart J 2021; 62:1310-1319. [PMID: 34853224 DOI: 10.1536/ihj.21-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prognostic impact of transfer to another hospital among acute heart failure (AHF) patients has not been well elucidated.Of the 800 AHF patients analyzed, 682 patients were enrolled in this study for analysis. The subjects were divided into two groups according to their discharge location: discharge home (Group-H, n = 589) or transfer to another hospital for rehabilitation (Group-T, n = 93). The Kaplan-Meier curves revealed a poorer prognosis, including all-cause death and heart failure (HF) events (death, readmission-HF), in Group-T than that in Group-H (P < 0.001, respectively). A multivariate Cox regression model showed that Group-T was an independent predictor of 365-day all-cause death (hazard ratio: 2.618, 95% confidence interval [CI]: 1.510-4.538, P = 0.001). The multivariate logistic regression analysis showed that aging (per 1-year-old increase, odds ratio [OR]: 1.056, 95% CI: 1.028-1.085, P < 0.001), female gender (OR: 2.128, 95% CI: 1.287-3.521, P = 0.003), endotracheal intubation during hospitalization (OR: 2.074, 95% CI: 1.093-3.936, P = 0.026), and increased Controlling Nutritional Status score on admission (per 1.0-point increase, OR: 1.247, 95% CI: 1.131-1.475, P < 0.001) were associated with transfer to another hospital after AHF admission. The prognosis, including all-cause death, was determined to be significantly poorer in patients who were transferred to another hospital, as their activities of daily living were noted to lessen before discharge (n = 11) compared to others (n = 82).Elderly AHF patients suffering from malnutrition were difficult to discharge home after AHF admission, and transfer to another hospital only led to adverse outcomes. Appropriate rehabilitation during definitive hospitalization appears necessary for managing elderly patients in the HF pandemic era.
Collapse
Affiliation(s)
- Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Shota Shigihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Yusuke Otsuka
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Hiroto Kokubun
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Tomoyo Miyakuni
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| |
Collapse
|
28
|
Cunha GJL, Rocha BML, Freitas P, Sousa JA, Paiva M, Santos AC, Guerreiro S, Tralhão A, Ventosa A, Aguiar CM, Andrade MJ, Abecasis J, Saraiva C, Mendes M, Ferreira AM. Pectoralis major muscle quantification by cardiac MRI is a strong predictor of major events in HF. Heart Vessels 2021; 37:976-985. [PMID: 34846560 DOI: 10.1007/s00380-021-01996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
Clinical overt cardiac cachexia is a late ominous sign in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). The main goal of this study was to assess the feasibility and prognostic significance of muscle mass quantification by cardiac magnetic resonance (CMR) in HF with reduced LVEF. HF patients with LVEF < 40% (HFrEF) referred for CMR were retrospectively identified in a single center. Key exclusion criteria were primary muscle disease, known infiltrative myocardial disease and intracardiac devices. Pectoralis major muscles were measured on standard axial images at the level of the 3rd rib anteriorly. Time to all-cause death or HF hospitalization was the primary endpoint. A total of 298 HF patients were included (mean age 64 ± 12 years; 76% male; mean LVEF 30 ± 8%). During a median follow-up of 22 months (IQR: 12-33), 67 (22.5%) patients met the primary endpoint (33 died and 45 had at least 1 HF hospitalization). In multivariate analysis, LVEF [Hazard Ratio (HR): 0.950; 95% Confidence Interval (CI): 0.917-0.983; p = 0.003), NYHA class I-II vs III-IV (HR: 0.480; CI: 0.272-0.842; p = 0.010), creatinine (HR: 2.653; CI: 1.548-4.545; p < 0.001) and pectoralis major area (HR: 0.873; 95% CI: 0.821-0.929; p < 0.001) were independent predictors of the primary endpoint, when adjusted for gender and NT-pro-BNP levels. Pectoralis major size measured by CMR in HFrEF was independently associated with a higher risk of death or HF hospitalization. Further studies to establish appropriate age and gender-adjusted cut-offs of muscle areas are needed to identify high-risk subgroups.
Collapse
Affiliation(s)
- Gonçalo J L Cunha
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal.
| | - Bruno M L Rocha
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Pedro Freitas
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - João A Sousa
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Mariana Paiva
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Ana C Santos
- Radiology Department, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Sara Guerreiro
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - António Tralhão
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - António Ventosa
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Carlos M Aguiar
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Maria J Andrade
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - João Abecasis
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Carla Saraiva
- Radiology Department, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - Miguel Mendes
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| | - António M Ferreira
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, Carnaxide, 2790-134, Lisbon, Portugal
| |
Collapse
|
29
|
Beetz NL, Maier C, Segger L, Shnayien S, Trippel TD, Lindow N, Bousabarah K, Westerhoff M, Fehrenbach U, Geisel D. First PACS‐integrated artificial intelligence‐based software tool for rapid and fully automatic analysis of body composition from CT in clinical routine. JCSM CLINICAL REPORTS 2021. [DOI: 10.1002/crt2.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Nick Lasse Beetz
- Department of Radiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
| | - Christoph Maier
- Department of Radiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Laura Segger
- Department of Radiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Seyd Shnayien
- Department of Radiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Tobias Daniel Trippel
- DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
- Department of Internal Medicine – Cardiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | | | | | | | - Uli Fehrenbach
- Department of Radiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Dominik Geisel
- Department of Radiology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| |
Collapse
|
30
|
Kamisaka K, Kamiya K, Iwatsu K, Iritani N, Imoto S, Adachi T, Iida Y, Yamada S. Impact of weight loss in patients with heart failure with preserved ejection fraction: results from the FLAGSHIP study. ESC Heart Fail 2021; 8:5293-5303. [PMID: 34599855 PMCID: PMC8712923 DOI: 10.1002/ehf2.13619] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/12/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023] Open
Abstract
Aims Weight loss (WL) is a poor prognostic factor for patients with heart failure (HF) with reduced ejection fraction. However, its prognostic impact on patients with HF with preserved ejection fraction (HFpEF) remains unestablished. The evidence regarding the effects of obesity on the prognosis of WL is also unclear. We aimed to identify the risk factors for WL and examine the association between WL and prognosis of HFpEF in obese and non‐obese patients. Methods and results In this multicentre cohort study, the data of 573 patients hospitalized with HFpEF [median age: 78 years (interquartile range, 71–84 years); 49.2% female] were identified from hospital databases. WL was defined as ≥5% weight reduction within 6 months after discharge. Obesity was defined according to Japanese criteria as body mass index ≥25 kg/m2. The main study outcomes were all‐cause mortality and HF rehospitalization between 6 and 24 months after hospital discharge. Logistic regression analysis and Cox proportional hazards regression analysis were performed to identify independent the risk factors associated with WL and to calculate the hazard ratios (HRs) associated with adverse outcomes. The prevalence of obesity at discharge was 21.1%. At 6 month follow‐up, WL occurred in 17.4% and 10.8% of the obese and non‐obese patients, respectively. Onset of WL in non‐obese patients was associated with prior hospitalization for HF [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.22–4.68, P = 0.011] and high levels of brain natriuretic peptide (OR 2.32, CI 1.17–4.60, P = 0.015). In obese patients, WL was associated with the use of mineralocorticoid receptor antagonists (OR 3.26, CI 1.08–9.76, P = 0.03) and vasopressin receptor antagonists (OR 6.61, CI 2.03–21.2, P = 0.001). During 1021.3 person‐years of follow‐up, 31 patients died, and upon 1081.0 person‐years follow‐up, 84 patients required rehospitalization for HF. In proportional hazards analysis, WL was associated with all‐cause mortality (HR 5.12, CI 2.08–12.5, P < 0.001) and HF rehospitalization (HR 2.63, CI 1.38–5.01, P = 0.003) after adjustment for confounders in non‐obese patients, but not in obese patients. Conclusions Weight loss should be considered as an indicator for monitoring worsening of HF condition in non‐obese patients with HFpEF. WL was not associated with adverse events in obese patients with HFpEF, possibly due to appropriate fluid management during follow‐up.
Collapse
Affiliation(s)
- Kenta Kamisaka
- Department of Rehabilitation, Kitano Hospital, Osaka, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Naoki Iritani
- Department of Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Shota Imoto
- Department of Rehabilitation, Kainan Hospital, Yatomi, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20, Daiko-minami, Higashi-ku, Nagoya, 4618673, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20, Daiko-minami, Higashi-ku, Nagoya, 4618673, Japan
| | | |
Collapse
|
31
|
Swolinsky JS, Nerger NP, Leistner DM, Edelmann F, Knebel F, Tuvshinbat E, Lemke C, Roehle R, Haase M, Costanzo MR, Rauch G, Mitrovic V, Gasanin E, Meier D, McCullough PA, Eckardt K, Molitoris BA, Schmidt‐Ott KM. Serum creatinine and cystatin C-based estimates of glomerular filtration rate are misleading in acute heart failure. ESC Heart Fail 2021; 8:3070-3081. [PMID: 33955699 PMCID: PMC8318462 DOI: 10.1002/ehf2.13404] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS We aimed to test whether the endogenous filtration markers serum creatinine or cystatin C and equation-based estimates of glomerular filtration rate (GFR) based on these markers appropriately reflect changes of measured GFR in patients with acute heart failure. METHODS In this prospective cohort study of 50 hospitalized acute heart failure patients undergoing decongestive therapy, we applied an intravenous visible fluorescent injectate (VFI), consisting of a low molecular weight component to measure GFR and a high molecular weight component to correct for measured plasma volume. Thirty-eight patients had two sequential GFR measurements 48 h apart. The co-primary endpoints of the study were safety of VFI and plasma stability of the high molecular weight component. A key secondary endpoint was to compare changes in measured GFR (mGFR) to changes of serum creatinine, cystatin C and estimated GFR. RESULTS VFI-based GFR measurements were safe and consistent with plasma stability of the high molecular weight component and glomerular filtration of the low molecular weight component. Filtration marker-based point estimates of GFR, when compared with mGFR, provided only moderate correlation (Pearson's r, range 0.80-0.88, depending on equation used), precision (r2 , range 0.65-0.78) and accuracy (56%-74% of estimates scored within 30% of mGFR). Correlations of 48-h changes GFR estimates and changes of mGFR were significant (P < 0.05) but weak (Pearson's r, range 0.35-0.39). Observed decreases of eGFR by more than 15% had a low sensitivity (range 38%-46%, depending on equation used) in detecting true worsening mGFR, defined by a >15% decrease in mGFR. CONCLUSIONS In patients hospitalized for acute heart failure, serum creatinine- and cystatin C-based predictions performed poorly in detecting actual changes of GFR. These data challenge current clinical strategies to evaluate dynamics of kidney function in acute heart failure.
Collapse
Affiliation(s)
- Jutta S. Swolinsky
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Niklas P. Nerger
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - David M. Leistner
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Campus Benjamin FranklinBerlinGermany
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research) Partner Site BerlinBerlinGermany
| | - Frank Edelmann
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research) Partner Site BerlinBerlinGermany
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Campus Virchow KlinikumBerlinGermany
| | - Fabian Knebel
- Department of Cardiology and AngiologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin, Campus MitteBerlinGermany
| | - Enkhtuvshin Tuvshinbat
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Caroline Lemke
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Robert Roehle
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- Institute of Biometry and Clinical EpidemiologyCharité – Universtitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Coordinating Center for Clinical StudiesCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Michael Haase
- Faculty of MedicineOtto von‐Guericke‐University MagdeburgMagdeburgGermany
| | | | - Geraldine Rauch
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- Institute of Biometry and Clinical EpidemiologyCharité – Universtitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | | | - Edis Gasanin
- Department of CardiologyKerckhoff KlinikBad NauheimGermany
| | | | - Peter A. McCullough
- Baylor University Medical Center, Baylor Heart and Vascular HospitalBaylor Heart and Vascular InstituteDallasTXUSA
| | - Kai‐Uwe Eckardt
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | | | - Kai M. Schmidt‐Ott
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Clinical Research UnitBerlin Institute of Health (BIH) at Charité – Universitätsmedizin BerlinBerlinGermany
- Max Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
| |
Collapse
|
32
|
Chronic Intravenous Inotropic Support as Palliative Therapy and Bridge Therapy for Patients With Advanced Heart Failure: A Single-Center Experience. J Card Fail 2021; 27:974-980. [PMID: 34153459 DOI: 10.1016/j.cardfail.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS. METHODS We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care. RESULTS Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SD] 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery. CONCLUSIONS In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.
Collapse
|
33
|
Kirschner SK, Deutz NEP, Rijnaarts I, Smit TJ, Larsen DJ, Engelen MPKJ. Impaired intestinal function is associated with lower muscle and cognitive health and well-being in patients with congestive heart failure. JPEN J Parenter Enteral Nutr 2021; 46:660-670. [PMID: 34021600 DOI: 10.1002/jpen.2193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Small- and large-intestinal perturbations have been described as prevalent extracardiac systemic manifestations in congestive heart failure (CHF), but alterations in protein digestion and absorption and plasma short-chain fatty acid (SCFA) concentrations and the potential link with other systemic effects (muscle and cognitive health) have not been investigated in CHF. METHODS We analyzed protein digestion and absorption with dual stable tracer method in 14 clinically stable, noncachectic CHF outpatients (mean left ventricular ejection fraction: 35.5% [95% CI, 30.9%-40.1%]) and 15 controls. Small-intestinal non-carrier-mediated permeability and active carrier-mediated glucose transport were quantified by sugar permeability test. Plasma SCFA (acetate, propionate, butyrate, isovalerate, valerate) concentrations were measured as intestinal microbial metabolites. Muscle function was assessed by isokinetic dynamometry, cognition by a battery of tests, and well-being by questionnaire. RESULTS Protein digestion and absorption were impaired by 29.2% (P = .001) and active glucose transport by 38.4% (P = .010) in CHF. Non-carrier-mediated permeability was not altered. Whereas plasma propionate, butyrate, and isovalerate concentrations were lower in CHF (P < .05), acetate and valerate concentrations did not differ. Overall, intestinal dysfunction was associated with impaired leg muscle quality, emotional distress, and cognitive dysfunction (P < .05). CONCLUSIONS We identified impaired protein digestion and absorption and altered SCFA concentrations as additional intestinal dysfunctions in CHF that are linked to reduced muscle and cognitive health and well-being. More research is needed to implement strategies to improve intestinal function in CHF and to investigate the mechanisms underlying its link with other systemic manifestations.
Collapse
Affiliation(s)
- Sarah K Kirschner
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Iris Rijnaarts
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Tiffany J Smit
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Daniel J Larsen
- Department of Heart and Vascular Care, Baylor Scott & White Clinic-College Station Rock Prairie, College Station, Texas, USA
| | - Mariëlle P K J Engelen
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW Heart failure (HF) is a structural or functional cardiac abnormality which leads to failure of the heart to deliver oxygen commensurately with the requirements of the tissues and it may progress to a generalized wasting of skeletal muscle, fat tissue, and bone tissue (cardiac cachexia). Clinically, dyspnea, fatigue, and exercise intolerance are some typical signs and symptoms that characterize HF patients. This review focused on the phenotypic characteristics of HF-induced skeletal myopathy as well as the mechanisms of muscle wasting due to HF and highlighted possible therapeutic strategies for skeletal muscle wasting in HF. RECENT FINDINGS The impaired exercise capacity of those patients is not attributed to the reduced blood flow in the exercising muscles, but rather to abnormal metabolic responses, myocyte apoptosis and atrophy of skeletal muscle. Specifically, the development of skeletal muscle wasting in chronic HF is characterized by structural, metabolic, and functional abnormalities in skeletal muscle and may be a result not only of reduced physical activity, but also of metabolic or hormonal derangements that favour catabolism over anabolism. In particular, abnormal energy metabolism, mitochondrial dysfunction, transition of myofibers from type I to type II, muscle atrophy, and reduction in muscular strength are included in skeletal muscle abnormalities which play a central role in the decreased exercise capacity of HF patients. Skeletal muscle alterations and exercise intolerance observed in HF are reversible by exercise training, since it is the only demonstrated intervention able to improve skeletal muscle metabolism, growth factor activity, and functional capacity and to reverse peripheral abnormalities.
Collapse
|
35
|
Triposkiadis F, Xanthopoulos A, Starling RC, Iliodromitis E. Obesity, inflammation, and heart failure: links and misconceptions. Heart Fail Rev 2021; 27:407-418. [PMID: 33829388 DOI: 10.1007/s10741-021-10103-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Obesity has been linked with heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF). This link has been attributed to obesity-induced metabolic and inflammatory disturbances leading to HFpEF. However, HF is a syndrome in which disease evolvement is associated with a dynamic unraveling of functional and structural changes leading to unique disease trajectories, creating a spectrum of phenotypes with overlapping distinct characteristics extending beyond the LV ejection fraction (LVEF). In this regard, despite quantitative differences between the two extremes (HFpEF and HF with reduced LVEF, HFrEF), there is important overlap between the phenotypes along the entire spectrum. In this paper, we describe the systemic pro-inflammatory state that is present throughout the HF spectrum and emphasize that obesity intertwines with HF beyond the LVEF construct.
Collapse
Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, Larissa, Greece
| | - Randall C Starling
- Heart, Vascular, and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, OH, Cleveland, USA
| | - Efstathios Iliodromitis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Athens, Greece
| |
Collapse
|
36
|
Israr MZ, Bernieh D, Salzano A, Cassambai S, Yazaki Y, Heaney LM, Jones DJL, Ng LL, Suzuki T. Association of gut-related metabolites with outcome in acute heart failure. Am Heart J 2021; 234:71-80. [PMID: 33454370 DOI: 10.1016/j.ahj.2021.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO), a gut-related metabolite, is associated with heart failure (HF) outcomes. However, TMAO is the final product of a complex metabolic pathway (ie, choline/carnitine) that has never been entirely investigated in HF. The present study investigates a panel of metabolites involved in the TMAO-choline/carnitine metabolic pathway for their associations with outcome in acute HF patients. METHODS In total, 806 plasma samples from acute HF patients were analyzed for TMAO, trimethyllysine, L-carnitine, acetyl-L-carnitine, γ-butyrobetaine, crotonobetaine, trimethylamine, betaine aldehyde, choline, and betaine using a developed liquid chromatography-tandem mass spectrometry method. Associations with outcome of all-cause mortality (death) and a composite of all-cause mortality and/or rehospitalization caused by HF (death/HF) at 30 days and 1 year were investigated. RESULTS TMAO, trimethyllysine, L-carnitine, acetyl-L-carnitine, and γ-butyrobetaine were associated with death and death/HF at 30 days (short term; hazard ratio 1.30-1.49, P≤ .021) and at 1 year (long term; hazard ratio 1.15-1.25, P≤ .026) when adjusted for cardiac risk factors. L-carnitine and acetyl-L-carnitine were superior for short-term outcomes whereas TMAO was the superior metabolite for association with long-term outcomes. Furthermore, acetyl-L-carnitine and L-carnitine were superior for in-hospital mortality and improved risk stratification when combined with current clinical risk scores (ie, Acute Decompensated HEart Failure National REgistry, Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure, and Get With The Guidelines-Heart Failure; odds ratio (OR) ≥ 1.52, P≤ .020). CONCLUSIONS Carnitine-related metabolites show associations with adverse outcomes in acute HF, in particular L-carnitine and acetyl-L-carnitine for short-term outcomes, and TMAO for long-term outcomes. Further studies are warranted to investigate the role and implications of carnitine metabolites including intervention in the pathogenesis of HF.
Collapse
Affiliation(s)
- Muhammad Zubair Israr
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Shabana Cassambai
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Yoshiyuki Yazaki
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Liam M Heaney
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom; School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Donald J L Jones
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom; Department of Cancer Studies, University of Leicester, RKCSB, Leicester, United Kingdom
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom.
| |
Collapse
|
37
|
Understanding the common mechanisms of heart and skeletal muscle wasting in cancer cachexia. Oncogenesis 2021; 10:1. [PMID: 33419963 PMCID: PMC7794402 DOI: 10.1038/s41389-020-00288-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Cachexia is a severe complication of cancer that adversely affects the course of the disease, with currently no effective treatments. It is characterized by a progressive atrophy of skeletal muscle and adipose tissue, resulting in weight loss, a reduced quality of life, and a shortened life expectancy. Although the cachectic condition primarily affects the skeletal muscle, a tissue that accounts for ~40% of total body weight, cachexia is considered a multi-organ disease that involves different tissues and organs, among which the cardiac muscle stands out for its relevance. Patients with cancer often experience severe cardiac abnormalities and manifest symptoms that are indicative of chronic heart failure, including fatigue, shortness of breath, and impaired exercise tolerance. Furthermore, cardiovascular complications are among the major causes of death in cancer patients who experienced cachexia. The lack of effective treatments for cancer cachexia underscores the need to improve our understanding of the underlying mechanisms. Increasing evidence links the wasting of the cardiac and skeletal muscles to metabolic alterations, primarily increased energy expenditure, and to increased proteolysis, ensuing from activation of the major proteolytic machineries of the cell, including ubiquitin-dependent proteolysis and autophagy. This review aims at providing an overview of the key mechanisms of cancer cachexia, with a major focus on those that are shared by the skeletal and cardiac muscles.
Collapse
|
38
|
Webster JM, Kempen LJAP, Hardy RS, Langen RCJ. Inflammation and Skeletal Muscle Wasting During Cachexia. Front Physiol 2020; 11:597675. [PMID: 33329046 PMCID: PMC7710765 DOI: 10.3389/fphys.2020.597675] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022] Open
Abstract
Cachexia is the involuntary loss of muscle and adipose tissue that strongly affects mortality and treatment efficacy in patients with cancer or chronic inflammatory disease. Currently, no specific treatments or interventions are available for patients developing this disorder. Given the well-documented involvement of pro-inflammatory cytokines in muscle and fat metabolism in physiological responses and in the pathophysiology of chronic inflammatory disease and cancer, considerable interest has revolved around their role in mediating cachexia. This has been supported by association studies that report increased levels of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in some, but not all, cancers and in chronic inflammatory diseases such as chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis (RA). In addition, preclinical studies including animal disease models have provided a substantial body of evidence implicating a causal contribution of systemic inflammation to cachexia. The presence of inflammatory cytokines can affect skeletal muscle through several direct mechanisms, relying on activation of the corresponding receptor expressed by muscle, and resulting in inhibition of muscle protein synthesis (MPS), elevation of catabolic activity through the ubiquitin-proteasomal system (UPS) and autophagy, and impairment of myogenesis. Additionally, systemic inflammatory mediators indirectly contribute to muscle wasting through dysregulation of tissue and organ systems, including GCs via the hypothalamus-pituitary-adrenal (HPA) axis, the digestive system leading to anorexia-cachexia, and alterations in liver and adipocyte behavior, which subsequently impact on muscle. Finally, myokines secreted by skeletal muscle itself in response to inflammation have been implicated as autocrine and endocrine mediators of cachexia, as well as potential modulators of this debilitating condition. While inflammation has been shown to play a pivotal role in cachexia development, further understanding how these cytokines contribute to disease progression is required to reveal biomarkers or diagnostic tools to help identify at risk patients, or enable the design of targeted therapies to prevent or delay the progression of cachexia.
Collapse
Affiliation(s)
- Justine M. Webster
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Laura J. A. P. Kempen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rowan S. Hardy
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Institute for Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
- MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
| | - Ramon C. J. Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
39
|
Abstract
Identifying patients with heart failure at high risk for poor outcomes is important for patient care, resource allocation, and process improvement. Although numerous risk models exist to predict mortality, hospitalization, and patient-reported health status, they are infrequently used for several reasons, including modest performance, lack of evidence to support routine clinical use, and barriers to implementation. Artificial intelligence has the potential to enhance the performance of risk prediction models, but has its own limitations and remains unproved.
Collapse
Affiliation(s)
- Ramsey M Wehbe
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA. https://twitter.com/ramseywehbemd
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA. https://twitter.com/HeartDocSadiya
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA. https://twitter.com/HFpEF
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 600, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA; Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, 15th Floor, Chicago, IL 60611, USA.
| |
Collapse
|
40
|
Kelm NQ, Straughn AR, Kakar SS. Withaferin A attenuates ovarian cancer-induced cardiac cachexia. PLoS One 2020; 15:e0236680. [PMID: 32722688 PMCID: PMC7386592 DOI: 10.1371/journal.pone.0236680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022] Open
Abstract
Cachexia is a common multifactorial syndrome in the advanced stages of cancer and accounts for approximately 20–30% of all cancer-related fatalities. In addition to the progressive loss of skeletal muscle mass, cancer results in impairments in cardiac function. We recently demonstrated that WFA attenuates the cachectic skeletal muscle phenotype induced by ovarian cancer. The purpose of this study was to investigate whether ovarian cancer induces cardiac cachexia, the possible pathway involved, and whether WFA attenuates cardiac cachexia. Xenografting of ovarian cancer induced cardiac cachexia, leading to the loss of normal heart functions. Treatment with WFA rescued the heart weight. Further, ovarian cancer induced systolic dysfunction and diastolic dysfunction Treatment with WFA preserved systolic function in tumor-bearing mice, but diastolic dysfunction was partially improved. In addition, WFA abrogated the ovarian cancer-induced reduction in cardiomyocyte cross-sectional area. Finally, treatment with WFA ameliorated fibrotic deposition in the hearts of tumor-bearing animals. We observed a tumor-induced MHC isoform switching from the adult MHCα to the embryonic MHCβ isoform, which was prevented by WFA treatment. Circulating Ang II level was increased significantly in the tumor-bearing, which was lowered by WFA treatment. Our results clearly demonstrated the induction of cardiac cachexia in response to ovarian tumors in female NSG mice. Further, we observed induction of proinflammatory markers through the AT1R pathway, which was ameliorated by WFA, in addition to amelioration of the cachectic phenotype, suggesting WFA as a potential therapeutic agent for cardiac cachexia in oncological paradigms.
Collapse
Affiliation(s)
- Natia Q. Kelm
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States of America
| | - Alex R. Straughn
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States of America
| | - Sham S. Kakar
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States of America
- Department of Physiology, University of Louisville, Louisville, KY, United States of America
- * E-mail:
| |
Collapse
|
41
|
Keller K, Hobohm L, Geyer M, Kreidel F, Ostad MA, Lavie CJ, Lankeit M, Konstantinides S, Münzel T, von Bardeleben RS. Impact of obesity on adverse in-hospital outcomes in patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip® procedure - Results from the German nationwide inpatient sample. Nutr Metab Cardiovasc Dis 2020; 30:1365-1374. [PMID: 32513574 DOI: 10.1016/j.numecd.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM The number of percutaneous edge-to-edge mitral regurgitation (MR) valve repairs with MitraClip® implantations increased exponentially in recent years. Studies have suggested an obesity survival paradox in patients with cardiovascular diseases. We investigated the influence of obesity on adverse in-hospital outcomes in patients with MitraClip® implantation. METHODS AND RESULTS We analyzed data on characteristics of patients and in-hospital outcomes for all percutaneous mitral valve repairs using the edge-to-edge MitraClip®-technique in Germany 2011-2015 stratified for obesity vs. normal-weight/over-weight. The nationwide inpatient sample comprised 13,563 inpatients undergoing MitraClip® implantations. Among them, 1017 (7.5%) patients were coded with obesity. Obese patients were younger (75 vs.77 years,P < 0.001), more often female (45.4% vs.39.5%,P < 0.001), had more often heart failure (87.1% vs.79.2%,P < 0.001) and renal insufficiency (67.0% vs.56.4%,P < 0.001). Obese and non-obese patients were comparable regarding major adverse cardiac and cerebrovascular events (MACCE) and in-hospital death. The combined endpoint of cardio-pulmonary resuscitation (CPR), mechanical ventilation and death was more often reached in non-obese than in obese patients with a trend towards significance (20.6%vs.18.2%,P = 0.066). Obesity was an independent predictor of reduced events regarding the combined endpoint of CPR, mechanical ventilation and death (OR 0.75, 95%CI 0.64-0.89,P < 0.001), but not for reduced in-hospital mortality (P = 0.355) or reduced MACCE rate (P = 0.108). Obesity class III was associated with an elevated risk for pulmonary embolism (OR 5.66, 95%CI 1.35-23.77,P = 0.018). CONCLUSIONS We observed an obesity paradox regarding the combined endpoint of CPR, mechanical ventilation and in-hospital death in patients undergoing MitraClip® implantation, but our results failed to confirm an impact of obesity on in-hospital survival or MACCE.
Collapse
Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Martin Geyer
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Mir A Ostad
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, United States
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité-University Medicine, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| |
Collapse
|
42
|
Duraes AR, da Silva WAP, Filho CRH, de Souza Lima Bitar Y, Neto MG. Heart Failure and Comorbidities—Part 2. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00211-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|