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. 2020 Oct;11(5):1242-1249.
doi: 10.1002/jcsm.12603. Epub 2020 Aug 6.

Muscle wasting as an independent predictor of survival in patients with chronic heart failure

Stephan von Haehling  1   2 , Tania Garfias Macedo  1 , Miroslava Valentova  1   2 , Markus S Anker  3   4 , Nicole Ebner  1   2 , Tarek Bekfani  5 , Helge Haarmann  1 , Joerg C Schefold  6 , Mitja Lainscak  7   8 , John G F Cleland  9   10 , Wolfram Doehner  3   11 , Gerd Hasenfuss  1   2 , Stefan D Anker  3
Affiliations

Muscle wasting as an independent predictor of survival in patients with chronic heart failure

Stephan von Haehling et al. J Cachexia Sarcopenia Muscle. 2020 Oct.

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.

Keywords: Cachexia; Heart failure; Sarcopenia; Survival; Wasting.

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Conflict of interest statement

S.v.H. has been a paid consultant for and/or received honoraria payments from AstraZeneca, Bayer, Boehringer Ingelheim, BRAHMS, Chugai, Grünenthal, Helsinn, Hexal, Novartis, Respicardia, Roche, Sorin, and Vifor. S.v.H. owns shares in Actimed. S.v.H. reports research support from IMI and the German Centre for Cardiovascular Research (DZHK). M.S.A. has received personal fees from Servier and research support from the DZHK (German Centre for Cardiovascular Research) and BMBF (German Ministry of Education and Research). The Department of Intensive Care Medicine (full departmental disclosure, J.C.S.) has/had research and development/consulting contracts (full disclosure) with Orion Corporation, Abbott Nutrition International, B. Braun Medical AG, CSEM SA, Edwards Lifesciences Services GmbH/SA, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, and Nestlé. Educational grants have been received from Fresenius Kabi, GSK, MSD, Lilly, Baxter, Astellas, AstraZeneca, B. Braun Medical AG, CSL Behring, Maquet, Novartis, Covidien, Nycomed, Pierre Fabre Pharma (Roba Pharma), Pfizer, and Orion Pharma. No personal financial gain resulted from respective development/consulting contracts and/or grants. W.D. reports speaker fees and advisory honoraria from Aimediq, Bayer, Boehringer Ingelheim, Medtronic, Pfizer, Sanofi‐Aventis, Sphingotec, and Vifor Pharma. W.D. also reports research support from EU (Horizon 2020), the German Ministry of Education and Research, German Centre for Cardiovascular Research, Vifor Pharma, and ZS Pharma. G.H. reports lecture fees and/or consultancy honoraria from AstraZeneca, Corvia, Impulse Dynamics, Novartis, Servier, and Vifor as well as fees for editorial board activities from Springer. S.D.A. reports personal fees from Bayer, Boehringer Ingelheim, Cardiac Dimension, Impulse Dynamics, Novartis, Servier, St. Jude Medical, and Vifor Pharma and grant support from Abbott Vascular and Vifor Pharma, outside the submitted work. All other authors do not have a conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves by status of muscle wasting in the overall cohort.
See this image and copyright information in PMC

References

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