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Int J Cardiol. 2016 Nov 1;222:41-46. doi: 10.1016/j.ijcard.2016.07.135. Epub 2016 Jul 14.

Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life.

Author information

1
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany. Electronic address: Tarek.bekfani@charite.de.
2
University of Hull, Department of Cardiology, Hull, United Kingdom. Electronic address: Pierpaolo.Pellicori@hey.nhs.uk.
3
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: Daniel-Armando.Morris@charite.de.
4
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: nicole.ebner@med.uni-goettingen.de.
5
University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany; Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic. Electronic address: miroslava.valentova@med.uni-goettingen.de.
6
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: lisa.steinbeck@gmx.de.
7
University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: wachter@med.uni-goettingen.de.
8
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: sebastian.elsner@charite.de.
9
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: veronika.sliziuk@charite.de.
10
Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland. Electronic address: joerg.schefold@insel.ch.
11
University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: anja.sandek@med.uni-goettingen.de.
12
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany. Electronic address: Wolfram.Doehner@charite.de.
13
University of Hull, Department of Cardiology, Hull, United Kingdom. Electronic address: J.G.Cleland@hull.ac.uk.
14
Golnik University, Department of Cardiology, Golnik, Slovenia. Electronic address: mitja.lainscak@guest.arnes.si.
15
University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: s.anker@cachexia.de.
16
Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: stephan.von.haehling@web.de.

Abstract

BACKGROUND:

To describe the prevalence of sarcopenia in ambulatory patients with heart failure with preserved ejection fraction (HFpEF) and its relation to reduced exercise capacity, muscle strength, and quality of life (QoL).

METHODS AND RESULTS:

A total of 117 symptomatic outpatients with HFpEF were prospectively enrolled in Germany, England, and Slovenia as part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Appendicular skeletal muscle (ASM) mass (the sum of muscle mass in both arms and legs) was assessed by DEXA. Echocardiography, 6-minute walk testing (6-MWT), muscle strength assessment, spiroergometry and QoL evaluation using EQ-5D Questionnaire were performed. Sarcopenia was defined as ASM 2 standard deviations below the mean of a healthy reference group aged 18-40years. Patients were divided into 3 groups according to the E/e' value: ≤8, 9-14, and ≥15. Sarcopenia was detected in 19.7% of all patients. These patients performed worse during 6-MWT (404±116 vs. 307±145m, p=0.003) and showed lower absolute peak oxygen consumption (1579±474 vs. 1211±442mL/min, p<0.05). Both ASM and muscle strength were lowest in patients with E/e' >15 (p<0.05). Higher values of muscle strength/ASM were associated with a better QoL (r=0.5, p<0.0005). Logistic regression showed ASM to be independently associated with reduced distance walked during the 6-MWT adjusted for NYHA, height, left atrium diameter, ferritin and forced expiratory volume in 1s (FEV1) (odds ratio 1.2, p=0.02).

CONCLUSION:

Sarcopenia affects a clinically relevant proportion of patients with HFpEF. Low ASM is strongly linked to reduced muscle strength, exercise capacity and QoL in these patients.

KEYWORDS:

Exercise capacity; Heart failure with preserved ejection fraction; Muscle wasting; Quality of life; Sarcopenia

PMID:
27454614
DOI:
10.1016/j.ijcard.2016.07.135
[Indexed for MEDLINE]
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