Sarcopenia in heart failure with reduced ejection fraction

Abstract

Aims: To evaluate the prevalence of pre-sarcopenia and sarcopenia and their relationship with clinical variables, physical activity, quality of life, and diet in patients with heart failure with reduced left ventricular ejection fraction (HFrEF).

Methods: We performed a cross-sectional study in patients with HFrEF and matched controls. Clinical, laboratory analysis, dual-emission X-ray densitometry, handgrip strength, and physical activity level questionnaire assessments were performed. Echocardiography, quality of life, gait speed, and 24-hour nutritional recall questionnaire were also analyzed. Pre-sarcopenia and sarcopenia were defined according to the European Working Group on Sarcopenia in Older People with the cut-off points of the Foundation for the National Institute of Health.

Results: 79 patients and 143 controls were enrolled. Pre-sarcopenia was found in 30.4%, and sarcopenia in 10.1% of the patients. Pre-sarcopenic patients were older and shorter, and had more fractures, higher calcemia, and creatinine (P < 0.05). Sarcopenic patients were older and had higher creatinine and TSH (P < 0.05). After multiple logistic regression analysis, only age was associated with pre-sarcopenia (OR: 1.046; CI 1.004-1.095; P = 0.04) and SP (OR: 1.119; CI 1.039-1.229; P = 0.008). Women with HFrEF presented higher lean mass than controls (P < 0.001), but were weaker (P < 0.001), while men presented lower lean mass (P < 0.001). Low gait speed was associated with right ventricular dysfunction (P = 0.016) and lower left ventricular ejection fraction (P = 0.037).

Conclusion: Pre-sarcopenia and sarcopenia were associated with aging. Despite having higher lean mass, women with HFrEF were weaker. Low gait speed was associated with biventricular systolic dysfunction.

Keywords: Frailty; heart failure; muscle wasting; sarcopenia; skeletal myopathy.

Figure 1

Sample selection. Flow diagram shows the steps followed to recruit patients and controls, the number of patients included, and excluded, the reasons for the exclusions and the final sample. ECHO: echocardiogram; CG: control group; HFG: heart failure group; SEMPR: endocrine division, Department of Internal Medicine, Federal University of Paraná, Curitiba, PR, Brazil; HFG: heart failure group; LVEF: left ventricular ejection fraction (%).

Figure 2

Quality of life (A) and plasma levels of N-terminal pro B-type Natriuretic Peptide (B) according to NYHA classification. (A) shows that quality of life worsened with the increasing of NYHA class from I to III, as well as NT-pro-BNP plasmatic levels (B). MLHFQ = Minnesota Living with Heart Failure Questionnaire; NYHA = New York Heart Association classification; NT-proBNP = N-terminal pro B-type natriuretic peptide.