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Bai B, Li D, Xu M, Liao Y, Zhou H, Liu F, Li W, Ma H. Clinical implication of sarcopenia in patients with acute decompensated heart failure: Design and rationale. ESC Heart Fail 2024. [PMID: 39225327 DOI: 10.1002/ehf2.15044] [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: 05/29/2024] [Revised: 07/20/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Sarcopenia is widely recognized as an age-related syndrome that involves a progressive loss of skeletal muscle mass and muscle strength. Many studies have shown that sarcopenia is associated with disease severity and exercise intolerance, as well as an independent predictor of mortality in patients with chronic heart failure. However, there is little research on the impact of sarcopenia on patients hospitalized with acute decompensated heart failure (ADHF). METHODS This is a prospective, multicentre, observational cohort study. Enrolment of at least 500 participants adults aged over 18 years hospitalized for ADHF is planned, with a minimum of 195 cases each for patients with and without sarcopenia. Each patient is followed up for 6 months, 1 year, 2 years or until the occurrence of endpoint. The primary clinical outcome is all-cause mortality at 6 months. Other clinical outcomes of interest include cardiovascular mortality, all-cause hospitalization, heart failure hospitalization and survival time from enrolment to event occurrence. The sympathetic nervous activity, psychosocial factors, quality of life, physical function, and physical activity will be assessed and recorded at baseline. This study will examine the correlation between sarcopenia and prognosis in different subgroups of patients, and explore the additive effect of different comorbidities and sarcopenia on prognosis in patients with ADHF. CONCLUSIONS This study will provide important information and evidence on the clinical aspects of sarcopenia in patients with ADHF, potentially contributing to accurate risk stratification and optimal clinical management for patients with ADHF. REGISTRATION (URL: https://www. CLINICALTRIALS gov); Unique identifier: NCT06298825.
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Affiliation(s)
- Bingqing Bai
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Dujuan Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Mingyu Xu
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Yingxue Liao
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Haofeng Zhou
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fengyao Liu
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- South China University of Technology, Guangzhou, China
| | - Wen Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Huan Ma
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Guzmán-Carreras A, San Miguel-Agudo J, Paz-Cabezas M, Bernabeu-Wittel M, Muñoz-Rivas N, Sánchez-Sauce B, Aguilar-Rodríguez F, Cabeza-Osorio L, Andrès E, Lorenzo-Villalba N, Méndez-Bailón M. Low Muscle Strength Assessed with Dynamometry in Elderly Polypathological Patients with Acute Heart Failure: PROFUND-IC Registry. J Clin Med 2024; 13:4873. [PMID: 39201014 PMCID: PMC11355444 DOI: 10.3390/jcm13164873] [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: 07/17/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Sarcopenia is a comorbidity associated with heart failure, which aggravates its prognosis. Objectives: To analyze the differential characteristics of polypathological patients with acute heart failure (AHF) based on the presence of low muscle strength, as well as to study whether this condition is associated with a worse prognosis. Methods: An observational study of 377 patients with a diagnosis of acute heart failure from the prospective multicentric PROFUND-IC registry was carried out. The main variable is low muscle strength, which is assessed with dynamometry or prehensile strength. Epidemiological and anthropometric characteristics, as well as associated comorbidities, were analyzed. Likewise, the etiology of the AHF episode, the number of admissions in the previous year, and the NYHA scale were also included. Finally, scores on functionality, treatment established, and mortality and readmission rates were studied. Quantitative variables are described as mean, and standard deviation, and qualitative variables are expressed as absolute numbers and percentages. A descriptive and bivariate analysis was performed according to the presence of low muscle strength (handgrip <27 kg in men and <16 kg in women), using the Welch test for quantitative measures and Chi-square for qualitative variables. In addition, Kaplan-Meier curves of readmission and mortality and a logistic regression analysis were also performed. Results: 377 patients were included (56% female, mean age 83 years). 310 (82.23%) had low muscle strength. Those with low muscle strength were older (84 vs. 78 years, p < 0.001), with more cognitive impairment (11.9% vs. 0%, p = 0.021), worse functional class (p = 0.016), lower scores in the Barthel index and Rockwood scale (p < 0.001), and higher in the PROFUND index (p < 0.001). They had higher rates of readmission and mortality without statistically significant differences. The PROFUND index is significantly associated with low muscle strength (OR 1.19, CI (1.09-1.31), p < 0.001). Conclusions: Elderly polypathological patients with acute heart failure and low muscle strength have a higher PROFUND index and a lower probability of survival per year.
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Affiliation(s)
| | - Jorge San Miguel-Agudo
- Faculty of Medicine. Universidad Complutense de Madrid, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Mateo Paz-Cabezas
- Unidad de Apoyo Metodológico a la Investigación, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | | | - Nuria Muñoz-Rivas
- Servicio de Medicina Interna, Hospital Infanta Leonor, 28031 Madrid, Spain
| | | | | | | | - Emmanuel Andrès
- Servicio de Medicina Interna, Hopitaux Universitaire de Strasbourg, 67000 Strasbourg, France
| | - Noel Lorenzo-Villalba
- Servicio de Medicina Interna, Hopitaux Universitaire de Strasbourg, 67000 Strasbourg, France
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Kronberger C, Mascherbauer K, Willixhofer R, Duca F, Rettl R, Binder-Rodriguez C, Poledniczek M, Ermolaev N, Donà C, Koschutnik M, Nitsche C, Camuz Ligios L, Beitzke D, Badr Eslam R, Bergler-Klein J, Kastner J, Kammerlander AA. Native skeletal muscle T1-time on cardiac magnetic resonance: A predictor of outcome in patients with heart failure with preserved ejection fraction. Eur J Intern Med 2024:S0953-6205(24)00314-5. [PMID: 39048334 DOI: 10.1016/j.ejim.2024.07.018] [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: 03/27/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is associated with heart failure (HF) hospitalizations and death. Previous studies have shown that altered muscle composition is associated with higher risk of adverse outcome in HFpEF patients. AIM The purpose of our study was to investigate the association between skeletal muscle composition, as measured by skeletal muscle T1-times on cardiac magnetic resonance (CMR) imaging, and adverse outcome. METHODS We measured skeletal muscle T1-times of the back muscles on standard CMR images in a prospective cohort of HFpEF patients. Cox regression models were used to test the association of skeletal muscle T1-times and adverse outcome defined as hospitalization for HF and/or cardiovascular death. RESULTS We included 101 patients (mean age 72±7 years, 71 % female) in our study. The median skeletal muscle T1-times were 842 ms (IQR 806-881 ms). In univariate analysis high muscle T1-time was associated with adverse outcome (HR=1.96 [95 % CI, 1.31-2.94] per every 100 ms increase; p=.001). After adjustment for age, sex, body mass index, left- and right ventricular ejection fraction, N-terminal pro-brain natriuretic peptide and myocardial native T1-times, native skeletal muscle T1-time remained an independent predictor for adverse outcome (HR=1.94 [95 % CI, 1.24-3.03] per every 100 ms increase; p=.004). CONCLUSION In patients with HFpEF, high skeletal muscle T1-times on standard CMR scans are associated with higher rates of HF hospitalizations and cardiovascular death. CONDENSED ABSTRACT Skeletal muscle abnormalities are common in patients with heart failure with preserved ejection fraction (HFpEF). The present study evaluates skeletal muscle composition, as quantified by native skeletal muscle T1-times of the back muscles on standard cardiac magnetic resonance imaging, and assessed the association with adverse outcome, defined as hospitalization for heart failure and/or cardiovascular death. In a prospective cohort of 101 patients with HFpEF, we found that high native skeletal muscle T1-times are associated with an increased risk for adverse outcome. These findings suggest that native skeletal muscle T1-time may serve as marker for improved risk prediction.
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Affiliation(s)
- Christina Kronberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Katharina Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Robin Willixhofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder-Rodriguez
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poledniczek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Nikita Ermolaev
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jutta Bergler-Klein
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas A Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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de Abreu Silva L, de Vasconcelos Generoso S, da Rocha VM, da Mata LAC, Castro CF, Ribeiro MV, Campolina BG, Duarte CK. Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:449-459. [PMID: 38417176 DOI: 10.1002/jpen.2611] [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] [Received: 02/28/2023] [Revised: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support. METHODS A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization. RESULTS A total of 261 patients were evaluated, with a median age of 61.0 (49.0-69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass. CONCLUSION There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.
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Affiliation(s)
- Luciana de Abreu Silva
- Post-graduation Program in Nutrition and Health, School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Simone de Vasconcelos Generoso
- Post-graduation Program in Nutrition and Health, School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Nutrition, School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Moreira da Rocha
- Nutritional Support Comission, Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Lincoln Antinossi Cordeiro da Mata
- Nutritional Support Comission, Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Fernandes Castro
- School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Vassallo Ribeiro
- School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Guerra Campolina
- School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Post-graduation Program in Nutrition and Health, School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Department of Nutrition, School of Nursing, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Yoshida K, Kobatake Y, Takashima S, Nishii N. Evaluation of muscle mass and intramuscular fatty infiltration in dogs with hypercortisolism and their association with prognosis. J Vet Intern Med 2024; 38:1334-1344. [PMID: 38622799 PMCID: PMC11099730 DOI: 10.1111/jvim.17065] [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] [Received: 08/18/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Muscle atrophy and intramuscular fatty infiltration, as well as their association with prognosis, have not been quantified in dogs with spontaneous hypercortisolism (HC). OBJECTIVE To quantitatively evaluate muscle atrophy and IM fatty infiltration in dogs with HC and determine their prognostic impact. ANIMALS Fifty-three dogs with HC and 66 control dogs without HC. METHODS Retrospective cohort study. Medical records and computed tomography images obtained between 2014 and 2021 were evaluated. Kaplan-Meier curves and log-rank tests were used to analyze the effect of muscle atrophy and IM fatty infiltration on the prognosis of dogs with HC. RESULTS Dogs with HC showed lower visually measured cross-sectional area (VCSA) and cross-sectional area based on attenuation (HCSA) than control dogs (median [interquartile range {IQR}]: 50.3 mm2/mm [36.2-67.8] vs 66.7 mm2/mm [48.0-85.9]; P < .001; 30.4 mm2/mm [13.7-57.2] vs 54.8 mm2/mm [39.7-71.5]; P < .001, respectively). Dogs with HC had lower epaxial muscle attenuation (L3HU) than control dogs (median [IQR]: 21.2 Hounsfield [HU] [12.4-28.2] vs 33.2 HU [22.6-43.6]; P < .001). Dogs with HC with lower HCSA or L3HU had shorter survival (median [IQR]: 670 days [222-673] vs 949 days [788-1074], P < .01; 523 days [132-670] vs 949 days [756-1074], P < .01, respectively) but not lower VCSA (median [IQR]: 673 days [132-788] vs 949 days [523 to not applicable]; P = .30). CONCLUSION AND CLINICAL IMPORTANCE Hypercortisolism in dogs causes muscle atrophy and IM fatty infiltration and is associated with poor prognosis.
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Affiliation(s)
- Kei Yoshida
- Joint Department of Veterinary MedicineThe United Graduate School of Veterinary Science, Gifu UniversityGifuJapan
| | - Yui Kobatake
- Joint Department of Veterinary MedicineFaculty of Applied Biological Science, Gifu UniversityGifuJapan
| | - Satoshi Takashima
- Joint Department of Veterinary MedicineFaculty of Applied Biological Science, Gifu UniversityGifuJapan
| | - Naohito Nishii
- Joint Department of Veterinary MedicineThe United Graduate School of Veterinary Science, Gifu UniversityGifuJapan
- Joint Department of Veterinary MedicineFaculty of Applied Biological Science, Gifu UniversityGifuJapan
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Ferreira VM, Rodrigues DN, Contreras CAM, Rossi JM, Ramos RF, Oliveira G, Oliveira MF. The Effects of Exercise on Cardiogenic Shock with an Intra-Aortic Balloon Pump: A Case Report. Arq Bras Cardiol 2024; 121:e20230537. [PMID: 38511808 PMCID: PMC11081090 DOI: 10.36660/abc.20230537] [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] [Received: 05/23/2023] [Revised: 12/12/2023] [Accepted: 11/14/2023] [Indexed: 03/22/2024] Open
Abstract
This case report describes the exercise program on a hospitalized 54-year-old male patient with cardiogenic shock waiting for a heart transplant assisted by an intra-aortic balloon pump, a temporary mechanical circulatory support device. The temporary mechanical circulatory support device, an intra-aortic balloon pump, was placed in the left subclavian artery, enabling the exercise protocol. Measurements and values from Swan-Ganz catheter, blood sample, brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP), as well as the six-minute walk test (6MWT) and venous oxygen saturation (SvO2) were obtained before and after an exercise protocol. The exercise training protocol involved the use of an unloaded bed cycle ergometer once a day, for a maximum of 30 minutes, to the tolerance limit. No adverse events or events related to the dislocation of the intra-aortic balloon pump were observed during the exercise protocol. The exercise program resulted in higher SvO2 levels, with an increased 6MWT with lower Borg dyspnea scores (312 meters vs. 488 meters and five points vs. three points, respectively). After completing the ten-day exercise protocol, the patient underwent a non-complicated heart transplant surgery and a full recovery in the ICU. This study showed that exercise is a feasible option for patients with cardiogenic shock who are using an intra-aortic balloon pump and that it is well-tolerated with no reported adverse events.
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Affiliation(s)
- Vanessa M. Ferreira
- Instituto Dante Pazzanese de CardiologiaCentro de Terapia IntensivaSão PauloSPBrasilCentro de Terapia Intensiva - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
| | - Dayane Nunes Rodrigues
- Instituto Dante Pazzanese de CardiologiaCentro de Terapia IntensivaSão PauloSPBrasilCentro de Terapia Intensiva - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
| | - Carlos Alberto Mendez Contreras
- Instituto Dante Pazzanese de CardiologiaUnidade de Cirurgia CardíacaSão PauloSPBrasilUnidade de Cirurgia Cardíaca - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
| | - João M. Rossi
- Instituto Dante Pazzanese de CardiologiaUnidade de Insuficiência CardíacaSão PauloSPBrasilUnidade de Insuficiência Cardíaca - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
| | - Rui Fernando Ramos
- Instituto Dante Pazzanese de CardiologiaCentro de Terapia IntensivaSão PauloSPBrasilCentro de Terapia Intensiva - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
| | - Gustavo Oliveira
- Instituto Dante Pazzanese de CardiologiaCentro de Terapia IntensivaSão PauloSPBrasilCentro de Terapia Intensiva - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
| | - Mayron F. Oliveira
- Instituto Dante Pazzanese de CardiologiaCentro de Terapia IntensivaSão PauloSPBrasilCentro de Terapia Intensiva - Instituto Dante Pazzanese de Cardiologia São Paulo, SP - Brasil
- Unidade de FisioterapiaGrupo de Pesquisa VO2 CareSão PauloSPBrasilGrupo de Pesquisa VO2 Care - Unidade de Fisioterapia, São Paulo, SP - Brasil
- Grupo de Fisiologia do Exercício e Pesquisa Cardiopulmonar IntegradaLyon CollegeBatesvilleAREUAGrupo de Fisiologia do Exercício e Pesquisa Cardiopulmonar Integrada - EPIC Group, Exercise Science, Lyon College, Batesville, AR - EUA
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Okita K, Omokawa M, Takada S, Kadoguchi T, Morita N, Yokota T. Muscular stress is equal when resistance exercise with blood flow restriction is matched in total work volume: A cross-sectional, cross-over study. Acta Physiol (Oxf) 2024; 240:e14097. [PMID: 38230807 DOI: 10.1111/apha.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/05/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024]
Abstract
AIM We compared muscular metabolic stress during exercise performed at multiple intensities, from very low to moderate, with blood flow restriction (BFR) adjusted by the same work volume. METHODS Twenty-five healthy young adults performed unilateral plantar flexion at 1 repetition/2 s in a magnetic resonance system. The BFR exercise protocols were as follows: (A) exercise with 10% of one repetition maximum (1-RM) for 360 s, (B) 15% 1-RM for 240 s, (C) 20% 1-RM for 180 s, (D) 30% 1-RM for 120 s, and (E) 40% 1-RM for 90 s. All protocols had the same total work volume (load × repetitions = 1800). A high-intensity protocol at 65% 1-RM without BFR (60 s) was also performed for comparison. We used 31 P-magnetic resonance spectroscopy to evaluate the muscular metabolic stress in the subjects' calf muscle, defined as decreases in phosphocreatine and intramuscular pH. RESULTS The phosphocreatine depletion (A: 15.6 ± 0.7, B: 14.8 ± 0.8, C: 15.2 ± 0.6, D: 14.3 ± 0.6, E: 10.9 ± 0.5 mM; no significant difference [ns]) and the intramuscular pH decrease (A: 6.82 ± 0.02, B: 6.84 ± 0.01, C: 6.83 ± 0.02, D: 6.83 ± 0.02, E: 6.77 ± 0.02; ns) at the end of each exercise were similar and greater than those produced by the 65% 1-RM without BFR. CONCLUSION If the total work volumes are equal, the metabolic stress in exercising muscle may reach similar levels at the end of exercise with BFR and could provide similar successful training effects.
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Affiliation(s)
- Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University, Ebetsu, Japan
| | - Masashi Omokawa
- Graduate School of Lifelong Sport, Hokusho University, Ebetsu, Japan
| | - Shingo Takada
- Graduate School of Lifelong Sport, Hokusho University, Ebetsu, Japan
| | | | - Noriteru Morita
- Department of Sport Cultural Studies, Hokkaido University of Education, Iwamizawa, Japan
| | - Takashi Yokota
- Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Ogawa A, Kanzaki S, Ikeda Y, Iwakawa M, Nakagami T, Sato S, Mikamo H, Kido S, Nakajima A, Shimizu K. Determination of Peak Oxygen Uptake in Patients with Acute Myocardial Infarction: The Role of Arterial Stiffness in Cardio-Vascular-Skeletal Muscle Coupling. J Clin Med 2023; 13:42. [PMID: 38202049 PMCID: PMC10780112 DOI: 10.3390/jcm13010042] [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: 11/01/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The relationship between arterial stiffness and oxygen uptake (VO2) in patients with acute myocardial infarction (AMI) remains unclear. We aimed to investigate this relationship and factors contributing to VO2 in patients with AMI. The role of arterial stiffness in cardio-skeletal muscle coupling during exercise was then elucidated. Upon discharge, we measured exercise capacity using cardiopulmonary exercise testing (CPX), assessed arterial stiffness with the cardio-ankle vascular index (CAVI), and determined body composition to assess the skeletal muscle mass of 101 patients with AMI. Patients were categorized based on their CAVI scores into three groups: (i) normal (CAVI: ≤7.9), (ii) borderline (CAVI: 8.0-8.9), and (iii) abnormal (CAVI: ≥9.0). Subsequently, VO2 was compared among these groups. The relationship between the CAVI and VO2 Peak during CPX and factors contributing to VO2 Peak were investigated. The abnormal CAVI group had a significantly lower VO2 Peak than the normal and borderline groups. The CAVI was associated with VO2 Peak. Furthermore, the CAVI was found to be a factor contributing to VO2 Peak. These findings suggest that arterial stiffness in tissue blood distribution and blood supply causes systemic exercise limits in patients with AMI. This suggests that arterial stiffness plays a significant role in cardio-vascular-skeletal muscle coupling.
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Affiliation(s)
- Akihiro Ogawa
- Department of Rehabilitation, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (S.K.); (A.N.)
- Graduate School of Health Sciences, Saitama Prefectural University, 820, Sannomiya, Koshigaya, Saitama 343-8540, Japan;
| | - Shinya Kanzaki
- Department of Rehabilitation, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (S.K.); (A.N.)
| | - Yuki Ikeda
- Department of Internal Medicine, Toho University Sakura Medical Center; 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (Y.I.); (M.I.); (T.N.); (S.S.); (H.M.); (K.S.)
| | - Masahiro Iwakawa
- Department of Internal Medicine, Toho University Sakura Medical Center; 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (Y.I.); (M.I.); (T.N.); (S.S.); (H.M.); (K.S.)
| | - Takahiro Nakagami
- Department of Internal Medicine, Toho University Sakura Medical Center; 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (Y.I.); (M.I.); (T.N.); (S.S.); (H.M.); (K.S.)
| | - Shuji Sato
- Department of Internal Medicine, Toho University Sakura Medical Center; 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (Y.I.); (M.I.); (T.N.); (S.S.); (H.M.); (K.S.)
| | - Hiroshi Mikamo
- Department of Internal Medicine, Toho University Sakura Medical Center; 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (Y.I.); (M.I.); (T.N.); (S.S.); (H.M.); (K.S.)
| | - Satoshi Kido
- Graduate School of Health Sciences, Saitama Prefectural University, 820, Sannomiya, Koshigaya, Saitama 343-8540, Japan;
| | - Arata Nakajima
- Department of Rehabilitation, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (S.K.); (A.N.)
| | - Kazuhiro Shimizu
- Department of Internal Medicine, Toho University Sakura Medical Center; 564-1, Shimoshizu, Sakura, Chiba 285-8741, Japan; (Y.I.); (M.I.); (T.N.); (S.S.); (H.M.); (K.S.)
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9
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Mangner N, Winzer EB, Linke A, Adams V. Locomotor and respiratory muscle abnormalities in HFrEF and HFpEF. Front Cardiovasc Med 2023; 10:1149065. [PMID: 37965088 PMCID: PMC10641491 DOI: 10.3389/fcvm.2023.1149065] [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: 01/20/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Heart failure (HF) is a chronic and progressive syndrome affecting worldwide billions of patients. Exercise intolerance and early fatigue are hallmarks of HF patients either with a reduced (HFrEF) or a preserved (HFpEF) ejection fraction. Alterations of the skeletal muscle contribute to exercise intolerance in HF. This review will provide a contemporary summary of the clinical and molecular alterations currently known to occur in the skeletal muscles of both HFrEF and HFpEF, and thereby differentiate the effects on locomotor and respiratory muscles, in particular the diaphragm. Moreover, current and future therapeutic options to address skeletal muscle weakness will be discussed focusing mainly on the effects of exercise training.
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Affiliation(s)
- Norman Mangner
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Ephraim B. Winzer
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
| | - Volker Adams
- Laboratory of Molecular and Experimental Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
- Dresden Cardiovascular Research Institute and Core Laboratories GmbH, Dresden, Germany
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10
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Gallagher H, Hendrickse PW, Pereira MG, Bowen TS. Skeletal muscle atrophy, regeneration, and dysfunction in heart failure: Impact of exercise training. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:557-567. [PMID: 37040849 PMCID: PMC10466197 DOI: 10.1016/j.jshs.2023.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 05/31/2023]
Abstract
This review highlights some established and some more contemporary mechanisms responsible for heart failure (HF)-induced skeletal muscle wasting and weakness. We first describe the effects of HF on the relationship between protein synthesis and degradation rates, which determine muscle mass, the involvement of the satellite cells for continual muscle regeneration, and changes in myofiber calcium homeostasis linked to contractile dysfunction. We then highlight key mechanistic effects of both aerobic and resistance exercise training on skeletal muscle in HF and outline its application as a beneficial treatment. Overall, HF causes multiple impairments related to autophagy, anabolic-catabolic signaling, satellite cell proliferation, and calcium homeostasis, which together promote fiber atrophy, contractile dysfunction, and impaired regeneration. Although both wasting and weakness are partly rescued by aerobic and resistance exercise training in HF, the effects of satellite cell dynamics remain poorly explored.
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Affiliation(s)
- Harrison Gallagher
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Paul W Hendrickse
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Marcelo G Pereira
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK.
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11
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Sunayama T, Fujimoto Y, Matsue Y, Dotare T, Daichi M, Yatsu S, Ishiwata S, Nakamura Y, Akama Y, Tsujimura Y, Suda S, Kato T, Hiki M, Kasai T, Minamino T. Prognostic value of estimating appendicular muscle mass in heart failure using creatinine/cystatin C. Nutr Metab Cardiovasc Dis 2023; 33:1733-1739. [PMID: 37407312 DOI: 10.1016/j.numecd.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND AIMS Heart failure with concomitant sarcopenia has a poor prognosis; therefore, simple methods for evaluating the appendicular skeletal muscle mass index (ASMI) are required. Recently, a model incorporating anthropometric data and the sarcopenia index (i.e., serum creatinine-to-cystatin C ratio [Cre/CysC]), was developed to estimate the ASMI. We hypothesized that this model was superior to the traditional model, which uses only anthropometric data to predict prognosis. This retrospective cohort study compared the prognostic value of low ASMI as defined by the biomarker and anthropometric models in patients with heart failure. METHODS AND RESULTS Among 847 patients, we estimated ASMI using an anthropometric model (incorporating age, body weight, and height) in 791 patients and a biomarker model (incorporating age, body weight, hemoglobin, and Cre/CysC) in 562 patients. The primary outcome was all-cause mortality. Overall, 53.4% and 39.1% of patients were diagnosed with low ASMI (using the Asian Working Group for Sarcopenia cut-off) by the anthropometric and biomarker models, respectively. The two models showed a poor agreement in the diagnosis of low ASMI (kappa: 0.57, 95% confidence interval: 0.50-0.63). Kaplan-Meier curves showed that a low ASMI was significantly associated with all-cause death in both models. However, this association was retained after adjustment for other covariates in the biomarker model (hazard ratio: 2.32, p = 0.001) but not in the anthropometric model (hazard ratio: 0.79, p = 0.360). CONCLUSION Among patients hospitalized with heart failure, a low ASMI estimated using the biomarker model, and not the anthropometric model, was significantly associated with all-cause mortality.
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Affiliation(s)
- Tsutomu Sunayama
- 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
| | - Yuya Matsue
- 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
| | - Maeda Daichi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuka Akama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichiro Tsujimura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, 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
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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12
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An J, Choi SP, Oh JH, Zhu JH, Kim SW, Kim SH. The Association between the L3 Skeletal Muscle Index Derived from Computed Tomography and Clinical Outcomes in Patients with Urinary Tract Infection in the Emergency Department. J Clin Med 2023; 12:5024. [PMID: 37568426 PMCID: PMC10420275 DOI: 10.3390/jcm12155024] [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: 05/25/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
The occurrence of a critical event during a urinary tract infection (UTI) can have a significant impact on mortality. This study aimed to investigate the association between the skeletal muscle index (SMI) and critical events in patients with a UTI. From April 2019 to March 2022, a total of 478 patients who met the diagnostic criteria of a UTI and underwent an abdominal CT were included in this study. Multivariate binary logistic regression analysis was used to assess independent predictors of critical events. The primary outcome was any critical event, defined as the initiation of dialysis, invasive ventilation, initiation of vasoactive medications, cardiac arrest, or death. The UTI patients were divided into two groups: those with a low SMI (n = 93) and those with a high SMI (n = 385). In multivariate analysis, a low SMI, diabetes mellitus, altered mentality, lactate levels, and creatinine levels were identified as significant predictors of critical events. A low SMI is an independent factor associated with the occurrence of critical events in UTI patients during hospitalization. Patients with a low SMI, indicating muscle wasting, may have less resilience to infections and a higher risk of experiencing severe complications. Considering the SMI along with other clinical factors can help health care providers assess and manage UTI patients.
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Affiliation(s)
- Jinjoo An
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Seung Pill Choi
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Jae Hun Oh
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Jong Ho Zhu
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Sung Wook Kim
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
| | - Soo Hyun Kim
- Department of Emergency, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea; (S.P.C.); (J.H.O.); (J.H.Z.); (S.W.K.)
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13
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Бровкина СС, Джериева ИС, Волкова НИ, Шкурат ТП, Гончарова ЗА, Машкина ЕВ, Решетников ИБ. [Association of the structure of the glucocorticoid receptor and single nucleotide NR3C1 gene polymorphisms with metabolic disorders]. PROBLEMY ENDOKRINOLOGII 2023; 69:50-58. [PMID: 36842077 PMCID: PMC9978877 DOI: 10.14341/probl13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 02/27/2023]
Abstract
Glucocorticoid therapy is widely used in the treatment of various pathologies. Sensitivity to glucocorticoids (GC) has a serious impact not only on the effectiveness of their action, but also on the severity of side effects, the formation of risk factors and the development of cardiovascular diseases (CVD). Variability of sensitivity to GC causes different phenotypes and severity of metabolic disorders underlying CVD. Among them, one can distinguish a decrease in muscle mass and strength, obesity, glucose and lipid metabolism impairment, and others. Glucocorticoids carry out their effects by binding to the glucocorticoid receptor (GR), and therefore this is considered a critical point in their action. This review presents data on the significance of the glucocorticoid receptor structure, examines the main single nucleotide polymorphisms (SNP) of the NR3C1 gene associated with hypersensitivity or relative resistance to glucocorticoids in the context of metabolic disorders and the development of CVD. The association of the four most studied SNP of the GR gene with metabolic risks is described in detail: BclI (rs41423247), N363S (rs56149945), ER22/23EK (rs6189/rs6190), GR-9ß (rs6198). Their determination can contribute to clarifying the prognosis of both the effectiveness of GC and the development of metabolic disorders, and subsequent early correction of CVD risk factors.
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14
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Jayanama K, Theou O, Godin J, Mayo A, Cahill L, Rockwood K. Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults. BMC Med 2022; 20:404. [PMID: 36280863 PMCID: PMC9594976 DOI: 10.1186/s12916-022-02596-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Parallel to growth of aging and obese populations, the prevalence of metabolic diseases is rising. How body mass index (BMI) relates to frailty and mortality across frailty levels is controversial. We examined the associations of high BMI with frailty and mortality and explored the effects of percent body fat on these associations. METHODS We included 29,937 participants aged ≥50 years from the 2001-2006 National Health and Nutrition Examination Survey (NHANES) cohorts (N=6062; 53.7% females) and from wave 1 (2004) of Survey of Health, Ageing and Retirement in Europe (SHARE) (N=23,875; 54% females). BMI levels were categorized as: normal: 18.5-24.9 kg/m2, overweight: 25.0-29.9, obese grade 1: 30.0-34.9, and obese grade 2 or 3: >35.0. A frailty index (FI) was constructed excluding nutrition-related items: 36 items for NHANES and 57 items for SHARE. We categorized the FI using 0.1-point increments: FI ≤ 0.1 (non-frail), 0.1 < FI ≤ 0.2 (very mildly frail), 0.2 < FI ≤ 0.3 (mildly frail), and FI > 0.3 (moderately/severely frail). Percent body fat was measured using DXA for NHANES participants. All-cause mortality data were obtained until 2015 for NHANES and 2017 for SHARE to estimate 10-year mortality risk. All analyses were adjusted for age, sex, educational, marital, employment, and smoking statuses. RESULTS Mean age of participants was 63.3±10.2 years for NHANES and 65.0±10.0 years for SHARE. In both cohorts, BMI levels ≥25 kg/m2 were associated with higher frailty, compared to normal BMI. In SHARE, having a BMI level greater than 35 kg/m2 increased mortality risk in participants with FI≤0.1 (HR 1.31, 95%CI 1.02-1.69). Overweight participants with FI scores >0.3 were at lower risk for mortality compared to normal BMI [NHANES (0.79, 0.64-0.96); SHARE (0.71, 0.63-0.80)]. Higher percent body fat was associated with higher frailty. Percent body fat significantly mediated the relationship between BMI levels and frailty but did not mediate the relationship between BMI levels and mortality risk. CONCLUSIONS Being overweight or obese is associated with higher frailty levels. In this study, we found that being overweight is a protective factor of mortality in moderately/severely frail people and obesity grade 1 may be protective for mortality for people with at least a mild level of frailty. In contrast, obesity grades 2 and 3 may be associated with higher mortality risk in non-frail people. The relationship between BMI and frailty is partially explained by body fat.
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Affiliation(s)
- Kulapong Jayanama
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
| | - Olga Theou
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia Canada
| | - Judith Godin
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
| | - Andrea Mayo
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
| | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University & Nova Scotia Health, Halifax, Nova Scotia Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
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15
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Takahashi Y, Kaji T, Yasui T, Yoshida A, Yonetani N, Suzue N, Katoh S, Maeda K, Sairyo K, Irahara M, Iwasa T. Ultrasonographic changes in quadriceps femoris thickness in women with normal pregnancy and women on bed rest for threatened preterm labor. Sci Rep 2022; 12:17506. [PMID: 36261471 PMCID: PMC9582004 DOI: 10.1038/s41598-022-22467-8] [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: 01/04/2022] [Accepted: 10/14/2022] [Indexed: 01/12/2023] Open
Abstract
This study aimed to evaluate the changes in quadriceps femoris muscle thickness during the pregnancy and postpartum periods and to elucidate the effect of bed rest for threatened preterm labor on muscle thickness. In 26 women with normal pregnancy, quadriceps femoris thickness was measured at 11-13, 26, 30, and 35 weeks' gestation, and at 3-5 days and 1 month postpartum using ultrasonography. In 15 pregnant women treated with bed rest for threatened premature labor, quadriceps femoris thickness was measured at 30 and 35 weeks' gestation and postpartum. In women with normal pregnancy, quadriceps femoris thickness increased, peaking at 35 weeks' gestation, followed by a postpartum decrease. In women on bed rest, quadriceps femoris thickness showed no significant change during the pregnancy and postpartum periods, and the muscle was significantly thinner at 35 weeks' gestation than that in women with normal pregnancy. In conclusion, a significant increase in quadriceps femoris muscle thickness during normal pregnancy was found using ultrasonography. Meanwhile, in pregnant women on bed rest treatment, the quadriceps femoris was significantly thinner in the late third trimester than that in normal pregnant women. Prolonged bed rest can affect normal changes in the quadriceps femoris muscle thickness during the pregnancy and postpartum periods.
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Affiliation(s)
- Yohei Takahashi
- grid.267335.60000 0001 1092 3579Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503 Japan
| | - Takashi Kaji
- grid.267335.60000 0001 1092 3579Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503 Japan
| | - Toshiyuki Yasui
- grid.267335.60000 0001 1092 3579Department of Reproductive and Menopausal Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Atsuko Yoshida
- grid.267335.60000 0001 1092 3579Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503 Japan
| | - Naoto Yonetani
- grid.267335.60000 0001 1092 3579Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503 Japan
| | - Naoto Suzue
- grid.415448.80000 0004 0421 3249Department of Orthopedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Red Cross Tokushima Hinomine Rehabilitation Center for People with Disabilities, Komatsushima, Japan
| | - Kazuhisa Maeda
- grid.472231.10000 0004 1772 315XDepartment of Obstetrics and Gynecology, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Koichi Sairyo
- grid.267335.60000 0001 1092 3579Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Minoru Irahara
- grid.267335.60000 0001 1092 3579Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503 Japan
| | - Takeshi Iwasa
- grid.267335.60000 0001 1092 3579Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503 Japan
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16
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Guler A, Gurbak I, Aydin S, Kahraman S, Tasbulak O, Ucar SU, Dogan AC, Topel C, Panc C, Cizgici AY, Kalkan AK, Yalcin AA, Erturk M. The relationship between sarcopenia and one-year mortality in patients with critical limb ischemia undergoing endovascular therapy below the knee. Vascular 2022; 31:513-520. [PMID: 36062475 DOI: 10.1177/17085381221124702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. METHODS A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. RESULTS We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan-Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. CONCLUSIONS Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.
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Affiliation(s)
- Arda Guler
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ismail Gurbak
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sinem Aydin
- Department of Radiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Serkan Kahraman
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Tasbulak
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Servet U Ucar
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Arda C Dogan
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cagdas Topel
- Department of Radiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cafer Panc
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Y Cizgici
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali K Kalkan
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet A Yalcin
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, 484473Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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17
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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.
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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
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18
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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.
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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
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19
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Pandhi P, Streng KW, Anker SD, Cleland JG, Damman K, Dickstein K, Pellicori P, Lang CC, Ng L, Samani NJ, Zannad F, Metra M, Rossignol P, Filippatos G, van Veldhuisen DJ, Voors AA, Ter Maaten JM. The value of spot urinary creatinine as a marker of muscle wasting in patients with new-onset or worsening heart failure. J Cachexia Sarcopenia Muscle 2021; 12:555-567. [PMID: 33742549 PMCID: PMC8200450 DOI: 10.1002/jcsm.12690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/07/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Muscle wasting and unintentional weight loss (cachexia) have been associated with worse outcomes in heart failure (HF), but timely identification of these adverse phenomena is difficult. Spot urinary creatinine may be an easily accessible marker to assess muscle loss and cachexia. This study investigated the association of urinary creatinine with body composition changes and outcomes in patients with new-onset or worsening HF (WHF). METHODS In BIOSTAT-CHF, baseline spot urinary creatinine measurements were available in 2315 patients with new-onset or WHF in an international cohort (index cohort) and a validation cohort of 1431 similar patients from Scotland. RESULTS Median spot urinary creatinine concentrations were 5.2 [2.7-9.6] mmol/L in the index cohort. Median age was 69 ± 12 years and 73% were men. Lower spot urinary creatinine was associated with older age, lower height and weight, worse renal function, more severe HF, and a higher risk of >5% weight loss from baseline to 9 months (odds ratio = 1.23, 95% CI = 1.09-1.39 per log decrease; P = 0.001). Spot urinary creatinine was associated with Evans criteria of cachexia (OR = 1.26 per log decrease, 95% CI = 1.04-1.49; P = 0.016) and clustered with markers of heart failure severity in hierarchical cluster analyses. Lower urinary creatinine was associated with poorer exercise capacity and quality of life (both P < 0.001) and predicted a higher rate for all-cause mortality [hazard ratio (HR) = 1.27, 95% CI = 1.17-1.38 per log decrease; P < 0.001] and the combined endpoints HF hospitalization or all-cause mortality (HR = 1.23, 95% CI = 1.15-1.31 per log decrease; P < 0.001). Significance was lost after addition of the BIOSTAT risk model. Analyses of the validation cohort yielded similar findings. CONCLUSIONS Lower spot urinary creatinine is associated with smaller body dimensions, renal dysfunction, and more severe HF in patients with new-onset/WHF. Additionally, lower spot urinary creatinine is associated with an increased risk of weight loss and a poorer exercise capacity/quality of life. Urinary creatinine could therefore be a novel, easily obtainable marker to assess (risk of) muscle wasting in HF patients.
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Affiliation(s)
- Paloma Pandhi
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen W Streng
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan D Anker
- Department of Cardiology (CVK), Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G Cleland
- Robertson Centre for Biostatistics & Clinical Trials Unit, University of Glasgow and Clinical Cardiology, National Heart & Lung Institute, Imperial College London, London, UK
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Faiez Zannad
- CHU de Nancy, Inserm CIC 1433, Université de Lorrain, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Patrick Rossignol
- Inserm, Centre d'Investigations Cliniques-Plurithématique 1433, Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT Network, Université de Lorraine, Nancy, France
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, School of Medicine, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece.,School of Medicine, University of Cyprus, Nicosia, Cyprus
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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Farsijani S, Xue L, Boudreau RM, Santanasto AJ, Kritchevsky SB, Newman AB. Body composition by computed tomography vs. dual energy x-ray absorptiometry: Long-term prediction of all-cause mortality in the Health ABC cohort. J Gerontol A Biol Sci Med Sci 2021; 76:2256-2264. [PMID: 33835154 DOI: 10.1093/gerona/glab105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Body composition assessment by computed tomography (CT) predicts health outcomes in diverse populations. However, its performance in predicting mortality has not been directly compared to dual-energy-X-ray-absorptiometry (DXA). Additionally, the association between different body compartments and mortality, acknowledging the compositional nature of human body, is not well-studied. Compositional Data Analysis, that is applied to multivariate proportion-type dataset, may help to account for the inter-relationships of body compartments by constructing log-ratios of components. Here, we determined the associations of baseline CT-based measures of mid-thigh cross-sectional areas vs. DXA measures of body composition with all-cause mortality in Health ABC cohort, using both traditional (individual body compartments) and Compositional Data Analysis (using ratios of body compartments) approaches. METHODS The Health ABC study assessed body composition in 2911 older adults in 1996-97. We investigated the individual and ratios of (by Compositional Analysis) body compartments assessed by DXA (lean, fat, and bone-mass) and CT (muscle, subcutaneous fat area, intermuscular fat (IMF), and bone) on mortality, using Cox proportional hazard models. RESULTS Lower baseline muscle area by CT (HRmen=0.56 [95%CI: 0.48-0.67], HRwomen=0.60 [0.48-0.74]), fat-mass by DXA (HRmen=0.48 [0.24-0.95]) were predictors of mortality in traditional Cox-regression analysis. Consistently, Compositional Data Analysis revealed that lower muscle area vs. IMF, muscle area vs. bone area, and lower fat-mass vs. lean-mass were associated with higher mortality in both sexes. CONCLUSION Both CT measure of muscle area and DXA fat-mass (either individually or relative to other body compartments) were strong predictors of mortality in both sexes in a community research setting.
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Affiliation(s)
- Samaneh Farsijani
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.,Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA
| | - Lingshu Xue
- Health Policy and Management; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.,Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA
| | - Adam J Santanasto
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.,Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.,Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA
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21
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Rozynek M, Kucybała I, Urbanik A, Wojciechowski W. Use of artificial intelligence in the imaging of sarcopenia: A narrative review of current status and perspectives. Nutrition 2021; 89:111227. [PMID: 33930789 DOI: 10.1016/j.nut.2021.111227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 01/10/2023]
Abstract
Sarcopenia is a muscle disease which previously was associated only with aging, but in recent days it has been gaining more attention for its predictive value in a vast range of conditions and its potential link with overall health. Up to this point, evaluating sarcopenia with imaging methods has been time-consuming and dependent on the skills of the physician. The solution for this problem may be found in artificial intelligence, which may assist radiologists in repetitive tasks such as muscle segmentation and body-composition analysis. The major aim of this review was to find and present the current status and future perspectives of artificial intelligence in the imaging of sarcopenia. We searched the PubMed database to find articles concerning the use of artificial intelligence in diagnostic imaging and especially in body-composition analysis in the context of sarcopenia. We found that artificial-intelligence systems could potentially help with evaluating sarcopenia and better predicting outcomes in a vast range of clinical situations, which could get us closer to the true era of precision medicine.
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Affiliation(s)
- Miłosz Rozynek
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland
| | - Iwona Kucybała
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland
| | - Andrzej Urbanik
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland
| | - Wadim Wojciechowski
- Jagiellonian University Medical College, Department of Radiology, Krakow, Poland.
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22
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Funamizu T, Nagatomo Y, Saji M, Iguchi N, Daida H, Yoshikawa T. Low muscle mass assessed by psoas muscle area is associated with clinical adverse events in elderly patients with heart failure. PLoS One 2021; 16:e0247140. [PMID: 33592068 PMCID: PMC7886171 DOI: 10.1371/journal.pone.0247140] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background Acute decompensated heart failure (ADHF) is a growing healthcare burden with increasing prevalence and comorbidities due to progressive aging society. Accumulating evidence suggest that low skeletal muscle mass has a negative impact on clinical outcome in elderly adult population. We sought to determine the significance of psoas muscle area as a novel index of low skeletal muscle mass in elderly patients with ADHF. Methods In this single-center retrospective observational study, we reviewed consecutive 865 elderly participants (65 years or older) who were hospitalized for ADHF and 392 were available for analysis (79 years [74–85], 56% male). Cross-sectional areas of psoas muscle at the level of fourth lumbar vertebra were measured by computed tomography and normalized by the square of height to calculate psoas muscle index (PMI, cm2/m2). Results Dividing the patients by the gender-specific quartile value (2.47 cm2/m2 for male and 1.68 cm2/m2 for female), we defined low PMI as the lowest gender-based quartile of PMI. Multiple linear regression analysis revealed female sex, body mass index (BMI), and E/e’, but not left ventricular ejection fraction, were independently associated with PMI. Kaplan-Meier analysis showed low PMI was associated with higher rate of composite endpoint of all-cause death and ADHF re-hospitalization (P = 0.033). Cox proportional hazard model analysis identified low PMI, but not BMI, was an independent predictor of the composite endpoint (Hazard ratio: 1.52 [1.06–2.16], P = 0.024). Conclusions PMI predicted future clinical adverse events in elderly patients with ADHF. Further studies are needed to assess whether low skeletal muscle mass can be a potential therapeutic target to improve the outcome of ADHF.
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Affiliation(s)
- Takehiro Funamizu
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
- Department of Cardiology, National Defense Medical College, Tokorozawa, Japan
- * E-mail:
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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23
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Ferreira JMM, Cunha P, Carneiro A, Vila I, Cunha C, Silva C, Longatto-Filho A, Mesquita A, Cotter J, Mansilha A, Correia-Neves M. Sarcopenia as a Prognostic Factor in Peripheral Arterial Disease: Descriptive Review. Ann Vasc Surg 2021; 74:460-474. [PMID: 33556522 DOI: 10.1016/j.avsg.2021.01.076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Determine the influence of sarcopenia on the prognosis of peripheral arterial disease (PAD). METHODS A systematic search of the PubMed and Cochrane Library databases was performed with the keywords and medical subject heading (MesH): "muscle, skeletal", "sarcopenia", "prognosis", "duration of stay", "death", "mortality", "patient readmission", "length of stay", "peripheral arterial disease", "intermittent claudication" and "critical limb ischemia". Papers published from January 2010 to October 2020 in English, French, Spanish and Portuguese were eligible for inclusion. The primary outcome was overall survival. Secondary outcomes included post-operative complications, amputation, length of hospital stay and hospital readmission. RESULTS Of 1071 papers, 8 articles and 1511 patients were included (68.96% male, mean age 71.83 years). Five papers found an inverse relationship between SM area and mortality. Matsubara (2015) found that the 5-year overall survival rates were lower for patients with sarcopenia (23.5% ± 0.18% vs 77.5% ± 0.09% P = 0.001). Matsubara (2016) registered 3-year cardiovascular event-free survival rates of 43.1% and 91.2% for patients with and without sarcopenia (P < 0.01). Juszczak (2018) found that survival was lower in patients with reduced total psoas area. Taniguchi (2019) found that 3-year overall survival rate was 60% for patients with sarcopenia and 87% for patients without sarcopenia (P < 0.05). Shimazoe (2019) concluded sarcopenia was a significant predictor of overall survival. Distinctly, Nyers (2017) concluded that higher ratio bilateral psoas area to L4 vertebral body was associated with an increased risk of death. Two other studies analyzed other characteristics of the SM (density and strength). McDermott (2012) and found that lower calf muscle density and strength were associated with an increase in mortality. Sugai (2019) concluded that patients with major cardiovascular and limb events had a lower SM density. CONCLUSIONS Lower SM area and mass seem to be associated with a higher mortality in PAD patients.
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Affiliation(s)
- Joana Margarida Magalhães Ferreira
- Vascular Surgery Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Pedro Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Isabel Vila
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Cunha
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristina Silva
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Adhemar Longatto-Filho
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal; Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Amílcar Mesquita
- Vascular Surgery Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Jorge Cotter
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Medicine Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Internal Medicine Department, Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Armando Mansilha
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Vascular Surgery Department, Hospital de São João, Porto, Portugal
| | - Margarida Correia-Neves
- Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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24
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Lenchik L, Barnard R, Boutin RD, Kritchevsky SB, Chen H, Tan J, Cawthon PM, Weaver AA, Hsu FC. Automated Muscle Measurement on Chest CT Predicts All-Cause Mortality in Older Adults From the National Lung Screening Trial. J Gerontol A Biol Sci Med Sci 2021; 76:277-285. [PMID: 32504466 PMCID: PMC7812435 DOI: 10.1093/gerona/glaa141] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Muscle metrics derived from computed tomography (CT) are associated with adverse health events in older persons, but obtaining these metrics using current methods is not practical for large datasets. We developed a fully automated method for muscle measurement on CT images. This study aimed to determine the relationship between muscle measurements on CT with survival in a large multicenter trial of older adults. METHOD The relationship between baseline paraspinous skeletal muscle area (SMA) and skeletal muscle density (SMD) and survival over 6 years was determined in 6,803 men and 4,558 women (baseline age: 60-69 years) in the National Lung Screening Trial (NLST). The automated machine learning pipeline selected appropriate CT series, chose a single image at T12, and segmented left paraspinous muscle, recording cross-sectional area and density. Associations between SMA and SMD with all-cause mortality were determined using sex-stratified Cox proportional hazards models, adjusted for age, race, height, weight, pack-years of smoking, and presence of diabetes, chronic lung disease, cardiovascular disease, and cancer at enrollment. RESULTS After a mean 6.44 ± 1.06 years of follow-up, 635 (9.33%) men and 265 (5.81%) women died. In men, higher SMA and SMD were associated with a lower risk of all-cause mortality, in fully adjusted models. A one-unit standard deviation increase was associated with a hazard ratio (HR) = 0.85 (95% confidence interval [CI] = 0.79, 0.91; p < .001) for SMA and HR = 0.91 (95% CI = 0.84, 0.98; p = .012) for SMD. In women, the associations did not reach significance. CONCLUSION Higher paraspinous SMA and SMD, automatically derived from CT exams, were associated with better survival in a large multicenter cohort of community-dwelling older men.
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Affiliation(s)
- Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ryan Barnard
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert D Boutin
- Department of Radiology, Stanford University Medical Center, California
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Josh Tan
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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25
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Myokines and Heart Failure: Challenging Role in Adverse Cardiac Remodeling, Myopathy, and Clinical Outcomes. DISEASE MARKERS 2021; 2021:6644631. [PMID: 33520013 PMCID: PMC7819753 DOI: 10.1155/2021/6644631] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a global medical problem that characterizes poor prognosis and high economic burden for the health system and family of the HF patients. Although modern treatment approaches have significantly decreased a risk of the occurrence of HF among patients having predominant coronary artery disease, hypertension, and myocarditis, the mortality of known HF continues to be unacceptably high. One of the most important symptoms of HF that negatively influences tolerance to physical exercise, well-being, social adaptation, and quality of life is deep fatigue due to HF-related myopathy. Myopathy in HF is associated with weakness of the skeletal muscles, loss of myofibers, and the development of fibrosis due to microvascular inflammation, metabolic disorders, and mitochondrial dysfunction. The pivotal role in the regulation of myocardial and skeletal muscle rejuvenation, attenuation of muscle metabolic homeostasis, and protection against ischemia injury and apoptosis belongs to myokines. Myokines are defined as a wide spectrum of active molecules that are directly synthesized and released by both cardiac and skeletal muscle myocytes and regulate energy homeostasis in autocrine/paracrine manner. In addition, myokines have a large spectrum of pleiotropic capabilities that are involved in the pathogenesis of HF including cardiac remodeling, muscle atrophy, and cardiac cachexia. The aim of the narrative review is to summarize the knowledge with respect to the role of myokines in adverse cardiac remodeling, myopathy, and clinical outcomes among HF patients. Some myokines, such as myostatin, irisin, brain-derived neurotrophic factor, interleukin-15, fibroblast growth factor-21, and growth differential factor-11, being engaged in the regulation of the pathogenesis of HF-related myopathy, can be detected in peripheral blood, and the evaluation of their circulating levels can provide new insights to the course of HF and stratify patients at higher risk of poor outcomes prior to sarcopenic stage.
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Bielecka-Dabrowa A, Ebner N, Dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 2020; 22:2314-2326. [PMID: 32949422 DOI: 10.1002/ejhf.2011] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022] Open
Abstract
The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Junishi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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von Haehling S, Garfias Macedo T, Valentova M, Anker MS, Ebner N, Bekfani T, Haarmann H, Schefold JC, Lainscak M, Cleland JGF, Doehner W, Hasenfuss G, Anker SD. Muscle wasting as an independent predictor of survival in patients with chronic heart failure. J Cachexia Sarcopenia Muscle 2020; 11:1242-1249. [PMID: 32767518 PMCID: PMC7567155 DOI: 10.1002/jcsm.12603] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Skeletal muscle wasting is an extremely common feature in patients with heart failure, affecting approximately 20% of ambulatory patients with even higher values during acute decompensation. Its occurrence is associated with reduced exercise capacity, muscle strength, and quality of life. We sought to investigate if the presence of muscle wasting carries prognostic information. METHODS Two hundred sixty-eight ambulatory patients with heart failure (age 67.1 ± 10.9 years, New York Heart Association class 2.3 ± 0.6, left ventricular ejection fraction 39 ± 13.3%, and 21% female) were prospectively enrolled as part of the Studies Investigating Co-morbidities Aggravating Heart Failure. Muscle wasting as assessed using dual-energy X-ray absorptiometry was present in 47 patients (17.5%). RESULTS During a mean follow-up of 67.2 ± 28.02 months, 95 patients (35.4%) died from any cause. After adjusting for age, New York Heart Association class, left ventricular ejection fraction, creatinine, N-terminal pro-B-type natriuretic peptide, and iron deficiency, muscle wasting remained an independent predictor of death (hazard ratio 1.80, 95% confidence interval 1.01-3.19, P = 0.04). This effect was more pronounced in patients with heart failure with reduced than in heart failure with preserved ejection fraction. CONCLUSIONS Muscle wasting is an independent predictor of death in ambulatory patients with heart failure. Clinical trials are needed to identify treatment approaches to this co-morbidity.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tarek Bekfani
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Wolfram Doehner
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,BCRT-Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany
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Low relative skeletal muscle mass predicts incident hypertension in Korean men: a prospective cohort study. J Hypertens 2020; 38:2223-2229. [PMID: 32618894 DOI: 10.1097/hjh.0000000000002530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Previous cross-sectional studies suggest an association between low muscle mass and hypertension. However, whether low muscle mass predicts the development of hypertension is unknown. The aim of this study is to investigate the relationship between relative muscle mass and incident hypertension in a large prospective cohort of Korean adults. METHODS In this prospective cohort study, we analyzed 132 324 participants without hypertension at baseline who underwent two health check-ups in 2012 and 2016 or in 2013 and 2017 with a 4-year interval. The participants were divided according to skeletal muscle mass index quartiles (Q1--Q4) according to their baseline skeletal muscle mass index [skeletal muscle mass index (%) = total skeletal muscle mass (kg)/body weight (kg) × 100). Multivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for the development of hypertension after 4 years. RESULTS After 4 years, 7180 (5.43%) participants developed hypertension. The incidence rates of hypertension were 12.11, 8.58, 6.93, and 4.37% in men and 4.02, 2.29, 1.73, and 1.18% in women in Q1, Q2, Q3, and Q4, respectively. The multivariate adjusted odds ratios (95% confidence intervals) for incident hypertension in Q1, Q2, and Q3, in comparison with Q4, were 1.46 (1.3-1.63), 1.31 (1.19-1.46), and 1.26 (1.14-1.40) in men and 0.97 (0.76-1.23), 1.12 (0.90-1.38), and 1.14 (0.92-1.42) in women, respectively. CONCLUSION Low relative skeletal muscle mass was independently and significantly associated with the incidence of hypertension only in Korean men. Further research is required to understand the underlying mechanisms of this relationship.
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Duan J, Zhu B, Wu Y, Chen Z, Yang L. Myokines: An Available Biomarker to Evaluate Cardiac Functions? Cardiology 2019; 142:211-212. [PMID: 31212283 DOI: 10.1159/000500320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/10/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jiahao Duan
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yeshun Wu
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zijun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ling Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China,
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