Possible sarcopenia and its association with hospital-associated dysphagia and decline in physical function: Findings from a heart failure patients prospective cohort study

BACKGROUND & AIMS

There is limited evidence regarding the association of sarcopenia with dysphagia and physical function in patients with heart failure. This study examined the association between possible sarcopenia and both swallowing and physical function in individuals with acute heart failure (AHF).

METHODS

This prospective cohort study included hospitalized patients with AHF. Possible sarcopenia was assessed on admission using calf circumference and grip strength according to an international diagnostic criteria. The primary outcome was dysphagia at discharge using the Food Intake Level Scale (FILS), and the secondary outcome was physical function at discharge using the Barthel Index (BI). Multiple regression analysis and logistic regression, adjusted for potential confounders, were used to examine the association between possible sarcopenia at admission and FILS and BI at discharge.

RESULTS

A total of 320 patients (mean age 81.5 years; 170 women) were included in the analysis; 199 (59.4%) were diagnosed with possible sarcopenia. Multivariate analysis showed that possible sarcopenia at admission was significantly associated with FILS at discharge (β = -0.1204; p = 0.039). Possible sarcopenia at admission was not significantly associated with BI at discharge (OR = 2.066; 95% CI, 0.910-4.692, p = 0.083).

CONCLUSIONS

Possible sarcopenia was associated with decline in swallowing function during hospitalization in patients with AHF. These findings highlight the need for early detection and treatment of possible sarcopenia in this setting.

Screening for sarcopenia with SARC-F in older patients hospitalized with cardiovascular disease

AIMS

SARC-F ≥ 4 points are used for detecting sarcopenia; however, finding a lower SARC-F cut-off value may lead to early detection of sarcopenia. We investigated the SARC-F score with the highest sensitivity and specificity values to identify sarcopenia in older patients with cardiovascular disease (CVD). Motor performances were also examined for each SARC-F score.

METHODS AND RESULTS

This retrospective cross-sectional study examined the sensitivity and specificity of every 1-point increase in the SARC-F score to predict sarcopenia. Eligible participants included patients with CVD (≥65 years old) who were admitted for acute CVD treatment and participated in cardiac rehabilitation. Patients completed the SARC-F questionnaire and the sarcopenia assessment. Area under the curves (AUCs) were investigated for the ability to predict sarcopenia. Multivariable linear regression was used to compare the mean value of physical functions (e.g. walking speed, leg strength, and 6 min walking distance) of each SARC-F score. A total of 1066 participants (63.8% male; median age: 76 years) were included. Sarcopenia was present in 401 patients. A SARC-F cut-off ≥2 presented the optimal balance between sensitivity (68.3%) and specificity (55.6%) to detect sarcopenia (AUCs = 0.658; 95% confidence interval: 0.625-0.691). When the patients had low scores (1-3), every 1 point increase in the SARC-F score was associated with lower physical functions such as lower muscle strength and shorter walking distance (all P < 0.001).

CONCLUSION

A SARC-F cut-off ≥2 was optimal for screening sarcopenia, and even a low SARC-F score is useful in detecting sarcopenia and low physical function at an early stage in patients with CVD.

Association between SARC-F scores and risk of adverse outcomes in older patients with cardiovascular disease: a prospective study at a tertiary hospital in the south of Vietnam

Introduction

Older patients typically face elevated mortality rates and greater medical resource utilization during hospitalizations compared to their younger counterparts. Sarcopenia, serving as a prognostic indicator, is related to disability, diminished quality of life, and increased mortality. The SARC-F questionnaire, known for its cost-effectiveness, offers a valuable means of assessing sarcopenia. This study aims to explore the association between SARC-F scores and risk of adverse outcomes in elderly patients with cardiovascular disease at a Ho Chi Minh City hospital.

Method

Participants aged 60 and above, admitted to the Department of Cardiology - Interventional and Cardiovascular Emergency of Thong Nhat Hospital in Ho Chi Minh City from November 2021 to June 2022, were recruited for the prospective, single-center study. The prognostic outcomes included all-cause death and the initial occurrence of emergency re-hospitalization within 6 months' post-discharge. The Kaplan-Meier analysis compared the overall survival rates between different SARC-F score groups.

Results

The study enrolled 285 patients with a median age of 74 (67, 81). During a 6-month follow-up period, there were 14 cases of mortality. A SARC-F score of 4 or higher was significantly associated with an increased risk of all-cause mortality, with HR of 2.02 (95% CI: 1.39-2.92, p < 0.001), and higher incidence of re-hospitalization events with RR of 1.66 (95% CI: 1.06 to 2.59, p = 0.026). Kaplan-Meier survival analysis indicated a notably higher mortality rate in the patients with high SARC-F scores (p < 0.001).

Conclusion

In elderly patients with cardiovascular disease, the SARC-F questionnaire could serve as a simple and cost-effective method for detecting mortality and the risk of re-hospitalization.

Cancer history and physical function in patients with cardiovascular disease

Both cancer and cardiovascular disease (CVD) cause skeletal muscle mass loss, thereby increasing the likelihood of a poor prognosis. We investigated the association between cancer history and physical function and their combined association with prognosis in patients with CVD. We retrospectively reviewed 3,796 patients with CVD (median age: 70 years; interquartile range [IQR]: 61-77 years) who had undergone physical function tests (gait speed and 6-minute walk distance [6MWD]) at discharge. We performed multiple linear regression analyses to assess potential associations between cancer history and physical function. Moreover, Kaplan-Meier curves and Cox regression analyses were used to evaluate prognostic associations in four groups of patients categorized by the absence or presence of cancer history and of high or low physical function. Multiple regression analyses showed that cancer history was significantly and independently associated with a lower gait speed and 6MWD performance. A total of 610 deaths occurred during the follow-up period (median: 3.1 years; IQR: 1.4-5.4 years). The coexistence of low physical function and cancer history in patients with CVD was associated with a significantly higher mortality risk, even after adjusting for covariates (cancer history/low gait speed, hazard ratio [HR]: 1.93, P < 0.001; and cancer history/low 6MWD, HR: 1.61, P = 0.002). Cancer history is associated with low physical function in patients with CVD, and the combination of both factors is associated with a poor prognosis.

Aster glehni Extract, Including Caffeoylquinic Acids as the Main Constituents, Induces PPAR β/δ-Dependent Muscle-Type Change and Myogenesis in Apolipoprotein E Knockout Mice

To probe the functions of Aster glehni (AG) extract containing various caffeoylquinic acids on dyslipidemia, obesity, and skeletal muscle-related diseases focused on the roles of skeletal muscle, we measured the levels of biomarkers involved in oxidative phosphorylation and type change of skeletal muscle in C2C12 cells and skeletal muscle tissues from apolipoprotein E knockout (ApoE KO) mice. After AG extract treatment in cell and animal experiments, western blotting, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA) were used to estimate the levels of proteins that participated in skeletal muscle type change and oxidative phosphorylation. AG extract elevated protein expression of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), phosphorylated 5'-AMP-activated protein kinase (p-AMPK), peroxisome proliferator-activated receptor beta/delta (PPARβ/δ), myoblast determination protein 1 (MyoD), and myoglobin in skeletal muscle tissues. Furthermore, it elevated the ATP concentration. However, protein expression of myostatin was decreased by AG treatment. In C2C12 cells, increments of MyoD, myoglobin, myosin, ATP-producing pathway, and differentiation degree by AG were dependent on PPARβ/δ and caffeoylquinic acids. AG extract can contribute to the amelioration of skeletal muscle inactivity and sarcopenia through myogenesis in skeletal muscle tissues from ApoE KO mice, and function of AG extract may be dependent on PPARβ/δ, and the main functional constituents of AG are trans-5-O-caffeoylquinic acid and 3,5-O-dicaffeoylquinic acid. In addition, in skeletal muscle, AG has potent efficacies against dyslipidemia and obesity through the increase of the type 1 muscle fiber content to produce more ATP by oxidative phosphorylation in skeletal muscle tissues from ApoE KO mice.

Provision of dietary education in UK-based cardiac rehabilitation: a cross-sectional survey conducted in conjunction with the British Association for Cardiovascular Prevention and Rehabilitation

Dietary education is a core component of cardiac rehabilitation (CR). It is unknown how or what dietary education is delivered across the UK. We aimed to characterise practitioners who deliver dietary education in UK CR and determine the format and content of the education sessions. A fifty-four-item survey was approved by the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) committee and circulated between July and October 2021 via two emails to the BACPR mailing list and on social media. Practitioners providing dietary education within CR programmes were eligible to respond. Survey questions encompassed: practitioner job title and qualifications, resources, and the format, content and individual tailoring of diet education. Forty-nine different centres responded. Nurses (65·1 %) and dietitians (55·3 %) frequently provided dietary education. Practitioners had no nutrition-related qualifications in 46·9 % of services. Most services used credible resources to support their education, and 24·5 % used BACPR core competencies. CR programmes were mostly community based (40·8 %), lasting 8 weeks (range: 2-25) and included two (range: 1-7) diet sessions. Dietary history was assessed at the start (79·6 %) and followed up (83·7 %) by most centres; barriers to completing assessment were insufficient time, staffing or other priorities. Services mainly focused on the Mediterranean diet while topics such as malnutrition and protein intake were lower priority topics. Service improvement should focus on increasing qualifications of practitioners, standardisation of dietary assessment and improvement in protein and malnutrition screening and assessment.

Clinical Impact of Improvement in Sarcopenia through Cardiac Rehabilitation in Patients with Heart Failure

OBJECTIVES

Sarcopenia in patients with heart failure (HF) is associated with poor prognosis. Cardiac rehabilitation (CR) decreases the incidence of adverse events in patients with HF. However, the clinical implications of improving sarcopenia status through CR remain unclear. This study investigated the relationship between the changes in sarcopenia status in patients with HF undergoing outpatient CR and the risk of mortality and adverse events.

DESIGN

This was a retrospective cohort study of patients hospitalized at the Kitasato University Hospital Cardiovascular Center for the treatment of HF between January 2007 and December 2020.

SETTING AND PARTICIPANTS

Patients with HF whose sarcopenia status was assessed at hospital discharge and following at least 3 months of outpatient CR were included. Based on the sarcopenia status, all patients were divided into 3 groups: patients without sarcopenia at discharge (ie, robust), patients with sarcopenia at discharge but no sarcopenia following CR (ie, improved), and patients with sarcopenia at discharge and following CR (ie, unimproved).

METHODS

Cox regression analysis was used to examine the risk of all-cause death associated with the 3 sarcopenia status groups.

RESULTS

Of 546 patients with HF (median age: 70 years; male: 63.6%), 377 (69.0%), 54 (9.9%), and 115 (21.1%) were classified as robust, improved, and unimproved, respectively. Multivariate Cox regression analysis showed that the unimproved group had a significantly greater risk of all-cause death when compared to the robust group [hazard ratio (HR) 2.603, 95% CI 1.375-4.930, P = .004], but it did not differ from the improved group (HR 1.403, 95% CI 0.598-3.293, P = .43).

CONCLUSIONS AND IMPLICATIONS

No improvement in sarcopenia status in patients with HF undergoing outpatient CR was associated with a higher risk of all-cause death. Sarcopenia may be an important target to improve the prognosis of patients with HF.

Prognostic Utility of Skeletal Muscle Mass Metrics in Patients With Heart Failure

BACKGROUND

Sarcopenia is associated with risks of various adverse outcomes, and the assessment of skeletal muscle mass is necessary for its diagnosis. However, heart failure (HF) is a syndrome characterised by fluid retention, which affects muscle mass measurements. Different measurement methods have been reported to have different prognostic implications. We investigated the association between skeletal muscle mass metrics measured with the use of bioelectrical impedance analysis (BIA) and anthropometric measures and prognosis in patients with HF.

METHODS

The findings of 869 consecutive patients with HF were reviewed. We investigated the skeletal muscle mass index (SMI) measured with the use of BIA, the mid-upper arm circumference (MUAC), the arm muscle circumference (AMC), and the calf circumference (CC), and the patients were divided into 3 groups according to the sex-specific tertiles of the skeletal muscle mass metrics. The end points were all-cause death and readmission due to HF.

RESULTS

The high MUAC and AMC groups showed significantly better prognoses than their respective low groups (combined events: high MUAC group hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.395-0.789 [P < 0.01]; high AMC group HR 0.505, 95% CI 0.359-0.710 [P < 0.01]), although high SMI and high CC were not associated with better prognoses.

CONCLUSIONS

Among patients with HF, MUAC and AMC are more associated with prognosis than SMI and CC, which are recommended in preexisting sarcopenia guidelines. MUAC and AMC may also be useful measures in sarcopenia assessments.

Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel

As the population ages, older adults represent an increasing proportion of patients referred to the cardiac catheterization laboratory. Older adults are the highest-risk group for morbidity and mortality, particularly after complex, high-risk percutaneous coronary interventions. Structured risk assessment plays a key role in differentiating patients who are likely to derive net benefit vs those who have disproportionate risks for harm. Conventional risk assessment tools from national cardiovascular societies typically rely on 3 pillars: 1) cardiovascular risk; 2) physiologic and hemodynamic risk; and 3) anatomic and procedural risks. We propose adding a fourth pillar: geriatric syndromes, as geriatric domains can supersede all other aspects of risk.

Preoperative decline in skeletal muscle strength of patients with cardiovascular disease affects postoperative pulmonary complication occurrence: a single-center retrospective study

BACKGROUND

Dynapenia, defined as age-related skeletal muscle strength decline, has been reported as a poor prognostic factor in patients with cardiovascular disease. Decline in skeletal muscle strength (DS), the main symptom of dynapenia, may be an important clinical indicator in patients undergoing cardiac surgery. However, the relationship between DS and postoperative pulmonary complication occurrence is unclear. Herein, we investigated the relationship between preoperative DS and postoperative pulmonary complication occurrence in patients undergoing cardiac surgery.

METHODS

We enrolled 125 patients who underwent cardiac surgery. DS was determined by low grip strength and quadriceps isometric strength. The patients were divided into DS and non-DS groups. The relationship between the clinical characteristics and preoperative physical function was compared, and factors associated with postoperative pulmonary complication occurrence were investigated using multivariate logistic regression analysis.

RESULTS

There were 42 (33.6%) patients in the DS group and 83 (66.4%) patients in the non-DS group. Compared with the non-DS group, the DS group was significantly older and had a higher body mass index and Japan SCORE (operative mortality rate and major complication rate). The DS group also had a lower estimated glomerular filtration rate and preoperative Barthel index than the non-DS group. Furthermore the DS group had a significantly higher incidence of postoperative pulmonary complications and length of intensive care unit stay, and their postoperative rehabilitation was prolonged compared to the non-DS group. Multivariate logistic regression analysis revealed that DS was a determinant of postoperative pulmonary complications (odds ratio 4.26, 95% confidence interval 1.63‒11.14).

CONCLUSIONS

We showed that preoperative DS was an independent risk factor for postoperative pulmonary complications in patients undergoing cardiac surgery. Skeletal muscle strength before cardiac surgery may be an important clinical indicator for predicting the prognosis of patients from post-surgery to discharge and for planning postoperative rehabilitation programs.

SARC-F predicts poor motor function, quality of life, and prognosis in older patients with cardiovascular disease and cognitive impairment

OBJECTIVES

We investigated whether SARC-F scores were associated with motor function, quality of life (QOL) related to physical function, and prognosis in older patients with cardiovascular disease (CVD) and cognitive impairment.

METHODS

This was a retrospective cross-sectional cohort study. The study population consisted of 408 patients with CVD (≥60 years old) who completed the SARC-F questionnaire and Mini-Cog, a cognitive function test, at discharge. Sarcopenia was defined as a total SARC-F score ≥ 4 points. Patients who were cognitively-preserved (Mini-Cog score ≥ 3 points) were excluded. Patients completed the handgrip strength, leg strength, usual gait speed, 6-minute walking distance, short physical performance battery score, and 36-item Short-Form Health Survey Physical Functioning (SF-36PF) tests before discharge. Associations of SARC-F with physical function, QOL, and prognoses (i.e., composite of all-cause death and emergency CVD rehospitalization and the number of CVD rehospitalizations) were investigated.

RESULTS

Sarcopenia (SARC-F score ≥ 4 points) was associated with poorer motor function test outcomes and SF-36PF scores (all P < 0.001). The correlations remained significant after adjusting for comorbidities (e.g., anemia, prior heart failure, and renal dysfunction). Sarcopenia was also associated with a poorer prognosis (hazard ratio: 1.574; 95 % confidence interval [CI], 1.011-2.445) and an increased risk of CVD rehospitalization (incidence rate ratio: 1.911; 95 % CI, 1.312-2.782) after adjusting for comorbidities.

CONCLUSIONS AND IMPLICATIONS

In older patients with CVD and cognitive impairment, the SARC-F questionnaire may be a simple and inexpensive tool for identifying patients with decreased motor function and a poor prognosis.

Stroke-Related Sarcopenia among Two Different Developing Countries with Diverse Ethnic Backgrounds (Cross-National Study in Egypt and China)

The prevalence of stroke-related sarcopenia differs according to the diagnostic criteria, the cut-off point for assessment, and ethnicity. Egypt and China are developing countries with different races where no research concerning stroke-related sarcopenia has been performed yet. We aimed to evaluate the prevalence of possible sarcopenia and confirmed sarcopenia among Egyptian and Chinese stroke survivors using the Asian Working Group of Sarcopenia (AWGS-2019) criteria and to assess the variables associated with the prevalence rate. A prospective cross-sectional study was carried out among 200 Egyptian and 195 Chinese stroke survivors from 2019 to 2021 using a structural health questionnaire. A hand-held dynamometer was used to measure grip strength. Anthropometric measures were used to estimate muscle mass. Data were analyzed using SPSS statistics version 20. p-values < 0.05 were considered statistically significant. The prevalence of possible sarcopenia ranged from 20.0% to 34.4% among Egyptian and Chinese groups, except for the Egyptian females where it was 52.0%. The prevalence of sarcopenia in both populations ranged from 13.6% to 18.6%. Pre-stroke independent variables that accelerated possible sarcopenia were age, history of dyslipidemia, diabetes mellitus, and ischemic heart disease, but stroke severity was a post-stroke risk factor. Age was the only pre-stroke variable for sarcopenia, while quitting smoking and having good nutritional status were variables for the reduction of possible sarcopenia. Quitting smoking, having a good nutritional status, and early rehabilitation reduced sarcopenia development. Controlling vascular risk factors, enhancing rehabilitation, and nutritional therapy are protective measures against sarcopenia. Longitudinal studies are required to identify further risk factors.

Benefits of a Balance Exercise Assist Robot in the Cardiac Rehabilitation of Older Adults with Cardiovascular Disease: A Preliminary Study

We examined whether adding robot-supported balance exercises to cardiac rehabilitation improves the ability to balance in older adults with cardiovascular disease (CVD). We conducted a prospective study in 52 older adults who had been hospitalized for worsening CVD. Once weekly for four months, for a total of sixteen sessions as outpatients, the subjects used a Balance Exercise Assist Robot (BEAR) to perform balance exercises and an ergometer for aerobic exercises. Participants’ mean age was 76.9 ± 6.8 years (range, 65−95 years), and their mean brain natriuretic protein level was 164.0 ± 190.0 pg/mL. After the intervention, participants showed significant improvements in gait speed (before, 1.06 ± 0.33 m/s; after, 1.23 ± 0.30 m/s; p < 0.001), Short Physical Performance Battery score (before, 10.02 ± 2.25; after, 10.88 ± 1.79; p ˂ 0.001), timed up-and-go (before, 11.11 ± 5.07 s; after, 9.45 ± 3.45 s; p ˂ 0.001), and knee extension (before, 26.97 ± 11.78 kgf; after, 30.13 ± 13.04 kgf; p = 0.001). Cardiac rehabilitation including exercises using BEAR improved physical functioning and the ability to balance in older adults with CVD. Frail and prefrail patients improved, whereas robust ones did not change.

Relationship between physical function at discharge and hospital meal intake in elderly patients with heart failure

The relationship between low physical function (LPF) at discharge and food intake percentage (FIP) during hospitalization is unclear. We aimed to clarify the relationship between LPF at discharge and FIP and the change in nutritional status during hospitalization in elderly patients with heart failure (HF), and determine cutoff values for FIP and change in nutritional status during hospitalization. We included 431 consecutive patients aged ≥ 65 years who were hospitalized for HF and underwent cardiac rehabilitation (CR) from 2017 to 2019. Physical function at discharge was classified into two groups according to the Short Performance Physical Battery (SPPB): low physical function (LPF) (SPPB ≤ 9) and high physical function (HPF) (SPPB > 9). We compared background, clinical parameters, pre-hospital walking level, CR progress, nutritional factors during hospitalization including FIP of the main dish and side dish, and changes in nutritional status using the Geriatric Nutritional Risk Index (ΔGNRI) at admission and discharge. Multiple logistic regression analysis was also performed. The final analysis included 213 patients (age, 81.6 years) divided into the LPF (n = 136) and HPF groups (n = 77). The LPF group showed low FIP and a high ΔGNRI value. Multivariate analysis showed FIP main dish, ΔGNRI, worsening renal function, pre-hospital walking level, and days to start of walking to be factors influencing LPF at discharge. Respective cutoff values for FIP main dish and ΔGNRI predicting LPF at discharge were 82.2% and 4.24. FIP main dish during hospitalization and ΔGNRI were associated with LPF at discharge.

Prevalence and Impact of Sarcopenia in Heart Failure: A Cross-Sectional Study

Background:

Abnormal structure and function of cardiac muscles in heart failure (HF) may lead to decreased muscle mass and muscle strength, including low physical performance. This may play an important role in the development of sarcopenia.

Objective:

The objectives of this study were to determine the prevalence of sarcopenia among patients with HF and to explore the association between sarcopenia and HF.

Methods:

A cross-sectional study of 152 patients with HF was conducted in Thammasat University Hospital and Central Chest Institute of Thailand. Sarcopenia was defined according to the Asian Working Group for Sarcopenia. Participants were requested to perform handgrip strength, gait speed, and muscle mass. Logistic regression analysis was used to examine the association between sarcopenia occurrence and HF.

Results:

The prevalence of sarcopenia in patients with HF was 19.8% (14.0% in men and 31.1% in women). Participants with sarcopenia had a significantly lower body mass index (BMI) than those without sarcopenia (p<0.001). In addition, patients with sarcopenia had significantly lower respiratory muscle strength than those without sarcopenia (p<0.01). Sarcopenia was found to be significantly associated with age, sex, BMI, and left ventricular ejection fraction (LVEF) (p<0.05). In addition, age, sex, BMI, and LVEF predicted skeletal muscle mass index (SMI) accounted for 76.8% of the variance.

Conclusion:

The prevalence of sarcopenia among patients with HF was similar to that reported in previous studies. Regarding risk factors, age, sex, BMI, and LVEF were related to sarcopenia in the female sex, advanced age, low BMI, and low LVEF.

Aberrant mitochondrial homeostasis at the crossroad of musculoskeletal ageing and non-small cell lung cancer

Cancer cachexia is accompanied by muscle atrophy, sharing multiple common catabolic pathways with sarcopenia, including mitochondrial dysfunction. This study investigated gene expression from skeletal muscle tissues of older healthy adults, who are at risk of age-related sarcopenia, to identify potential gene biomarkers whose dysregulated expression and protein interference were involved in non-small cell lung cancer (NSCLC). Screening of the literature resulted in 14 microarray datasets (GSE25941, GSE28392, GSE28422, GSE47881, GSE47969, GSE59880 in musculoskeletal ageing; GSE118370, GSE33532, GSE19804, GSE18842, GSE27262, GSE19188, GSE31210, GSE40791 in NSCLC). Differentially expressed genes (DEGs) were used to construct protein-protein interaction networks and retrieve clustering gene modules. Overlapping module DEGs were ranked based on 11 topological algorithms and were correlated with prognosis, tissue expression, and tumour purity in NSCLC. The analysis revealed that the dysregulated expression of the mammalian mitochondrial ribosomal proteins, Mitochondrial Ribosomal Protein S26 (MRPS26), Mitochondrial Ribosomal Protein S17 (MRPS17), Mitochondrial Ribosomal Protein L18 (MRPL18) and Mitochondrial Ribosomal Protein L51 (MRPL51) were linked to reduced survival and tumour purity in NSCLC while tissue expression of the same genes followed an opposite direction in healthy older adults. These results support a potential link between the mitochondrial ribosomal microenvironment in ageing muscle and NSCLC. Further studies comparing changes in sarcopenia and NSCLC associated cachexia are warranted.

Frailty and Different Exercise Interventions to Improve Gait Speed in Older Adults after Acute Coronary Syndrome

Background and Objectives: The world’s population is rapidly aging, and it is estimated that, by 2050, every sixth person on earth will be older than 65 years. Around 30% of older adults entering cardiac rehabilitation (CR) meet the criteria of frailty. Frailty identification has not been included in the routine evaluation of CR patients yet, and there is a lack of evidence on what training regimen for improving physical performance in frail people is optimal. Therefore, the aim of our study was to determine the prevalence of frailty and to evaluate the effect of two different complementary training programs on the gait speed of older vulnerable and frail patients with acute coronary syndrome and mid-range-to-preserved left ventricular ejection fraction (≥40%) during short-term CR. Materials and Methods: This randomized controlled trial was conducted from January 2020 to September 2021. CR participants (n = 97) with a mean age of 73.1 ± 5.3 years were randomly allocated into three groups: control (CG, n = 32), intervention-1 (IG-1, n = 32) and intervention-2 (IG-2, n = 33). The patients of all three groups attended a usual inpatient CR program, and two intervention groups additionally received different resistance and balance training programs 3 days a week: the IG-1 underwent complementary training with traditional means of physical therapy, while the IG-2 underwent complementary training with mechanical devices. The mean CR duration was 18.9 ± 1.7 days. Frailty was assessed with the Edmonton Frail Scale, and the 5 m walk test was used to evaluate gait speed. Results: Frailty was determined in 37.1% of participants, and 42.3% met the criteria of being vulnerable. After CR, the gait speed of frail and vulnerable patients significantly improved in all three groups (p < 0.05). In the IG-2, slow gait speed was reversed to normal in the overwhelming majority of patients (p < 0.05), while the CG had the greatest proportion of patients who remained to be slow after CR (p < 0.05). Conclusions: A considerable part of patients entering CR are frail or vulnerable; therefore, it is of crucial importance to assess frailty status in all older people. All three CR programs improved gait speed in frail and vulnerable older patients with ischemic heart disease. Complementary resistance and balance training with mechanical devices more effectively reversed slow gait speed to normal during short-term CR.

Sarcopenic obesity as a determinant of cardiovascular disease risk in older people: a systematic review

BACKGROUND

Aging is associated with body composition changes that include a reduction of muscle mass or sarcopenia and an increase in visceral obesity. Thus, aging involves a muscle-fat imbalance with a shift toward more fat and less muscle. Therefore, sarcopenic obesity, defined as a combination of sarcopenia and obesity, is a global health phenomenon due to the increased aging of the population combined with the increased epidemic of obesity. Previous studies have shown inconsistent association between sarcopenic obesity and the risk of cardiovascular disease (CVD).

AIMS

To systematically review the recent literature on the CVD risks associated with sarcopenic obesity and summarizes ways of diagnosis and prevention.

METHODS

A systematic review of studies that reported the association between sarcopenic obesity and CVD risk in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

RESULTS

Risk factors of sarcopenic obesity included genetic factors, aging, malnutrition, sedentary lifestyle, hormonal deficiencies and other molecular changes. The muscle-fat imbalance with increasing age results in an increase in the pro-inflammatory adipokines secreted by adipocytes and a decline in the anti-inflammatory myokines secreted by myocytes. This imbalance promotes and perpetuates a chronic low-grade inflammatory state that is characteristic of sarcopenic obesity. After application of exclusion criteria, only 12 recent studies were included in this review. The recent studies have shown a consistent association between sarcopenic obesity and cardiovascular disease risk although most of the studies are of cross-sectional design that does not confirm a causal relationship. In addition, most of the population studied were of Asian origin which may limit the generalizability of the results. Non-pharmacological interventions by exercise training and adequate nutrition appear to be useful in maintenance of muscle strength and muscle mass in combination with a reduction of adiposity to promote healthy aging.

CONCLUSIONS

Sarcopenic obesity appears to increase the risk of CVD in older people; however, future prospective studies of diverse population are still required. Although non-pharmacologic interventions are useful in reducing the risk of sarcopenic obesity, novel specific pharmacologic agents are lacking.

A Case Study of an 87-Year-Old Male Bodybuilder with Complex Health Conditions

This exploratory clinical case report presents an 87-year-old man who began bodybuilding at the age of 76 years and was officially recognised as the world’s oldest competitive bodybuilder, competing until age 83. He has a background of complex health conditions including polio, strokes, cardiac arrest, atrial fibrillation, prostate disease, osteoarthritis, depression, bowel obstruction, reflux, and bladder cancer. Assessments of body composition, bone density, muscle performance, and diet-related practices were performed. The bodybuilder had superior fat-free mass, lower fat mass, and generally greater muscle performance compared to untrained healthy males of a similar age. Commencement of bodybuilding in older age appears to be possible, even with ongoing complex health conditions, and the potential benefits of this practice require systematic investigation in the future.

Principles of the activin receptor signaling pathway and its inhibition

This review captures the anabolic and stimulatory effects observed with inhibition of the transforming growth factor β superfamily in muscle, blood, and bone. New medicinal substances that rectify activin, myostatin, and growth differentiation factor 11 signaling give hope to the many whose lives are affected by deterioration of these tissues. The review first covers the origin, structure, and common pathway of activins, myostatin, and growth differentiation factor 11 along with the pharmacodynamics of the new class of molecules designed to oppose the activin receptor signaling pathway. Current terminology surrounding this new class of molecules is inconsistent and does not infer functionality. Adopting inhibitors of the activin receptor signaling pathway (IASPs) as a generic term is proposed because it encapsulates the molecular mechanisms along the pathway trajectory. To conclude, a pragmatic classification of IASPs is presented that integrates functionality and side effects based on the data available from animals and humans. This provides researchers and clinicians with a tool to tailor IASPs therapy according to the need of projects or patients and with respect to side effects.

Phase Angle as an Indicator of Sarcopenia, Malnutrition, and Cachexia in Inpatients with Cardiovascular Diseases

Malnutrition is associated with sarcopenia, cachexia, and prognosis. We investigated the usefulness of phase angle (PhA) as a marker of sarcopenia, cachexia, and malnutrition in 412 hospitalized patients with cardiovascular disease. We analyzed body composition with bioelectrical impedance analysis, and nutritional status such as controlling nutritional status (CONUT) score. Both skeletal muscle mass index (SMI) and PhA correlated with age, grip strength and knee extension strength (p < 0.0001) in both sexes. The SMI value correlated with CONUT score, Hb, and Alb in males. Phase angle also correlated with CONUT score, Hb, and Alb in males, and more strongly associated with these nutritional aspects. In females, PhA was correlated with Hb and Alb (p < 0.001). In both sexes, sarcopenia incidence was 31.6% and 32.4%; PhA cut-off in patients with sarcopenia was 4.55° and 4.25°; and cachexia incidence was 11.5% and 14.1%, respectively. The PhA cut-off in males with cachexia was 4.15°. Multivariate regression analysis showed that grip strength and brain natriuretic peptide (BNP) were independent determinants of SMI, whereas grip strength, BNP, and Hb were independent determinants of PhA. Thus, PhA appears to be a useful marker for sarcopenia, malnutrition, and cachexia in hospitalized patients with cardiovascular disease.

Prognostic value of sarcopenic obesity estimated by computed tomography in patients with cardiovascular disease and undergoing surgery

BACKGROUND

Sarcopenic obesity is a health condition involving a combination of excess adipose tissue and loss of muscle mass. Although sarcopenic obesity is known to contribute to the morbidity and mortality of chronic diseases, limited data are available in patients with cardiovascular disease. The present study was performed to examine whether sarcopenic obesity determined by preoperative computed tomography (CT) is a useful predictor of postoperative mortality in patients undergoing cardiovascular surgery.

METHODS

We reviewed the findings in 664 consecutive cardiovascular surgery patients (mean age, 65.8±12.7 years; male, 66.6%) who underwent preoperative CT including the level of the third lumbar vertebra for clinical purposes. Psoas muscle attenuation (MA) and visceral adipose tissue (VAT) were measured as metrics of sarcopenia and obesity, respectively. Sarcopenia was defined as low MA (below median), while obesity was defined as high VAT (≥103cm² for males and ≥69cm² for females). The endpoint was all-cause mortality and secondary outcomes were muscle function.

RESULTS

After adjusting for age and sex, sarcopenic obesity showed significant associations with lower grip strength and quadriceps strength, slower gait speed, and shorter 6-min walking distance compared to the normal group (p<0.05). On multivariate Cox regression analysis, sarcopenic obesity was associated with increased risk of mortality after adjusting for EuroSCORE (hazard ratio, 3.04; 95% confidence interval, 1.25-7.40).

CONCLUSIONS

Sarcopenic obesity is associated with poor muscle function and all-cause mortality in patients undergoing cardiovascular surgery.

SARC-F questionnaire identifies physical limitations and predicts post discharge outcomes in elderly patients with cardiovascular disease

Background A simple and inexpensive sarcopenia screening tool would be beneficial in clinical practice. This study was performed to determine whether SARC-F questionnaire can be used to identify physical limitations and poor prognosis in elderly cardiovascular disease (CVD) patients.Methods The study population consisted of 257 Japanese patients ≥65 years old admitted to our hospital for CVD. Prior to discharge from hospital, SARC-F, handgrip strength, usual gait speed, short physical performance battery score, and 6-minute walking distance were measured in all patients. The patients were divided into two groups according to SARC-F score: SARC-F <4 and SARC-F ≥4. The study endpoint was the first occurrence of all-cause emergency readmission or all-cause mortality.Results The prevalence rate of SARC-F ≥4 was 26.8%, and increased with age and number of comorbidities. Even after adjusting for covariates, physical function was significantly poorer and the risks of physical function measurements below the critical cut-off values were higher in the SARC-F ≥4 group compared to the SARC-F <4 group. Sixty (23.3%) patients were readmitted and 17 (6.6%) died over a median follow-up period of 11 months (interquartile range: 6–13 months). SARC-F score was a significant predictor of adverse events after discharge. Patients with SARC-F ≥4 showed higher event risk than those with SARC-F <4 (adjusted hazard ratio: 1.78; 95% confidence interval: 1.03–3.07; P = 0.040).Conclusions SARC-F questionnaire is useful to identify patients at high risk of physical limitations and to predict post-discharge outcomes in elderly CVD patients.