Muscle Wasting in Patients With Chronic Heart Failure
Muscle Wasting in Patients With Chronic Heart Failure
Aims To assess the prevalence and clinical impact of reductions in the skeletal muscle mass of patients with chronic heart failure (HF). Chronic HF is accompanied by co-morbidities that influence the quality of life and outcomes.
Methods and results We prospectively enrolled 200 patients with chronic HF. The appendicular skeletal muscle mass of the arms and the legs combined, was assessed by dual energy X-ray absorptiometry. We analysed the muscle strength in arms and legs, and all patients underwent a 6-min walk test, a 4-m walk test, and spiroergometry testing. Muscle wasting was defined as the appendicular muscle mass 2 SD below the mean of a healthy reference group of adults aged 18–40 years, as suggested for the diagnosis of muscle wasting in healthy ageing (sarcopenia). Muscle wasting was detected in 39 (19.5%) subjects. Patients with muscle wasting had significantly lower values for handgrip and quadriceps strength as well as lower total peak oxygen consumption (peakVO2, 1173 ± 433 vs. 1622 ± 456 mL/min), lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001), and lower left ventricular ejection fraction (LVEF, P = 0.05) than patients without.
The distance walked during 6 min and the gait speed during the 4-m walk were lower in patients with muscle wasting (both P < 0.05). Serum levels of interleukin-6 were significantly elevated in patients with muscle wasting (P = 0.001). Logistic regression showed muscle wasting to be independently associated with reduced peak VO2 adjusted for age, sex, New York Heart Association class, haemoglobin, LVEF, distance walked in 6 minutes, and the number of co-morbidities (odds ratio 6.53, p = 0.01).
Conclusion Muscle wasting is a frequent co-morbidity among patients with chronic HF. Patients with muscle wasting present with reduced exercise capacity and muscle strength, and advanced disease.
Muscles undergo permanent changes. After age 50, the muscle mass declines by 1–2% annually and the muscle strength decreases by ~1.5%. This age-related muscle loss, termed sarcopenia, affects ~10% of elderly subjects aged 60–70 years. After the age of 80, up to 50% of people can be affected. Muscle wasting is not only a problem in the elderly, but also a consequence of chronic diseases. Pathophysiological processes can cause changes in metabolism and may consequently yield increased catabolism. A discussion is currently ongoing whether or not the use of the term sarcopenia should be restricted to 'healthy ageing' and whether another descriptive term may be more appropriate in the setting of elderly patients with chronic disease. In this sense, muscle wasting reflects sarcopenia in chronic disease.
The prevalence and the impact of muscle wasting in heart failure (HF) have not been investigated yet. Chronic HF affects up to 14 million people in Europe alone. The prognosis of chronic HF is poor and comparable with some types of cancer. Half of the patients die within 4 years of diagnosis. Chronic HF is often accompanied by co-morbidities, such as anaemia, chronic kidney disease, diabetes mellitus, or cachexia. All these co-morbidities have been shown to be associated with decreased exercise capacity and with functional impairment in affected patients. The connection between chronic HF and weight loss has already been established some years ago, but it has not been described whether changes in muscle strength and function occur and whether these changes impact on the patients' functional capability.
The Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) is a prospective, multinational, observational project into the co-morbidities type 2 diabetes mellitus, cachexia, and obesity in patients with chronic HF. We hypothesized that muscle wasting is prevalent among patients with chronic HF and has a significant impact on the patients' clinical status and on parameters of functional capacity.
Abstract and Introduction
Abstract
Aims To assess the prevalence and clinical impact of reductions in the skeletal muscle mass of patients with chronic heart failure (HF). Chronic HF is accompanied by co-morbidities that influence the quality of life and outcomes.
Methods and results We prospectively enrolled 200 patients with chronic HF. The appendicular skeletal muscle mass of the arms and the legs combined, was assessed by dual energy X-ray absorptiometry. We analysed the muscle strength in arms and legs, and all patients underwent a 6-min walk test, a 4-m walk test, and spiroergometry testing. Muscle wasting was defined as the appendicular muscle mass 2 SD below the mean of a healthy reference group of adults aged 18–40 years, as suggested for the diagnosis of muscle wasting in healthy ageing (sarcopenia). Muscle wasting was detected in 39 (19.5%) subjects. Patients with muscle wasting had significantly lower values for handgrip and quadriceps strength as well as lower total peak oxygen consumption (peakVO2, 1173 ± 433 vs. 1622 ± 456 mL/min), lower exercise time (7.7 ± 3.8 vs. 10.22 ± 3.0 min, both P < 0.001), and lower left ventricular ejection fraction (LVEF, P = 0.05) than patients without.
The distance walked during 6 min and the gait speed during the 4-m walk were lower in patients with muscle wasting (both P < 0.05). Serum levels of interleukin-6 were significantly elevated in patients with muscle wasting (P = 0.001). Logistic regression showed muscle wasting to be independently associated with reduced peak VO2 adjusted for age, sex, New York Heart Association class, haemoglobin, LVEF, distance walked in 6 minutes, and the number of co-morbidities (odds ratio 6.53, p = 0.01).
Conclusion Muscle wasting is a frequent co-morbidity among patients with chronic HF. Patients with muscle wasting present with reduced exercise capacity and muscle strength, and advanced disease.
Introduction
Muscles undergo permanent changes. After age 50, the muscle mass declines by 1–2% annually and the muscle strength decreases by ~1.5%. This age-related muscle loss, termed sarcopenia, affects ~10% of elderly subjects aged 60–70 years. After the age of 80, up to 50% of people can be affected. Muscle wasting is not only a problem in the elderly, but also a consequence of chronic diseases. Pathophysiological processes can cause changes in metabolism and may consequently yield increased catabolism. A discussion is currently ongoing whether or not the use of the term sarcopenia should be restricted to 'healthy ageing' and whether another descriptive term may be more appropriate in the setting of elderly patients with chronic disease. In this sense, muscle wasting reflects sarcopenia in chronic disease.
The prevalence and the impact of muscle wasting in heart failure (HF) have not been investigated yet. Chronic HF affects up to 14 million people in Europe alone. The prognosis of chronic HF is poor and comparable with some types of cancer. Half of the patients die within 4 years of diagnosis. Chronic HF is often accompanied by co-morbidities, such as anaemia, chronic kidney disease, diabetes mellitus, or cachexia. All these co-morbidities have been shown to be associated with decreased exercise capacity and with functional impairment in affected patients. The connection between chronic HF and weight loss has already been established some years ago, but it has not been described whether changes in muscle strength and function occur and whether these changes impact on the patients' functional capability.
The Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) is a prospective, multinational, observational project into the co-morbidities type 2 diabetes mellitus, cachexia, and obesity in patients with chronic HF. We hypothesized that muscle wasting is prevalent among patients with chronic HF and has a significant impact on the patients' clinical status and on parameters of functional capacity.
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