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.

We examined the relationship between Short Physical Performance Battery (SPPB) and clinical and laboratory factors and the effect of sarcopenia and sarcopenic obesity (SO) on clinical and laboratory factors for cardiovascular disease (CVD) inpatients. CVD male (n = 318) and female (n = 172) inpatients were recruited. A stepwise multiple-regression analysis was performed to predict total SPPB scores and assess clinical and laboratory factors (physical characteristics, functional and morphological assessments, etc.). Each test outcome were compared among sarcopenia, SO and non-sarcopenic groups. To predict total SPPB scores, the predicted handgrip, Controlling Nutritional Status score, % body fat, anterior mid-thigh muscle thickness, standing height and systolic blood pressure were calculated for males and anterior mid-thigh MTH, BMI, knee extension and fat mass were calculated for females. There were no differences in blood pressure, total SPPB scores and functional assessments between sarcopenia and SO groups for CVD male and female inpatients. In conclusion, the physical performance of CVD inpatients can be predicted by nutritional, functional, clinical and anthropometric variables, regardless the gender and the presence of sarcopenia. Furthermore, the presence of sarcopenia has a negative effect on the clinical and laboratory factors, but there is a difference in impact between sarcopenia and SO regardless the gender.

Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients.

No abstract

We report a case in which a favorable course was obtained by using KAATSU training ® and BCAA intake early after aortic valve replacement surgery. The patient was a 43-year-old male with low cardiac function who underwent aortic valve replacement surgery. Heart failure and hypotension persisted while waiting for surgery. He tended to line on a bed all day, so that disuse muscular atrophy advanced. Therefore, in addition to the postoperative rehabilitation program, KAATSU training and BCAA intake were performed postoperatively and continued in outpatient rehabilitation. The KAATSU training was performed using knee extension twice or three times a week. For BCAA intake (2.5 g), one pack of jelly containing BCAA (Reha-Time Jelly, Clinico Co., Ltd.) was taken within 30 minutes after the training. About 3 months later, the thigh circumference (+ 7.3 cm), the maximum voluntary isometric contraction of knee extension (+ 20 kgf), the quadriceps muscle thickness (+ 1 cm) evaluated by a B-mode ultrasound, the muscle mass of the lower limb (+ 1 kg), and a marked increase in thigh muscle cross-sectional area as measured by CT scan were observed. No deterioration of circulatory hemodynamics and side effects were observed during the course. In conclusion, the combined use of KAATSU training and BCAA intake early after cardiac operation seems to be a safe and effective way to obtain muscle hypertrophy and muscle strengthening, but further studies are needed to clarify it.

No abstract

The purpose of this study was to examine whether KAATSU training improves femoris quadriceps muscle brightness in postoperative patients with valvular heart disease. The subjects were five patients (65.2 ± 10.1 years old; three males and two females; two with aortic stenosis, one with aortic regurgitation, and two with mitral regurgitation) after valvular heart surgery. KAATSU training was performed twice a week for 3 months after cardiac operation, and the patients were evaluated before and 3 months after the start of training. Grip strength and knee extension strength were measured. The mid-thigh was imaged in the resting supine position using an ultrasound imaging system, and the femoris quadriceps muscle brightness was calculated using image analysis software (ImageJ). The anterior thigh muscle thickness was defined as the thickness of the rectus femoris and anterior vastus intermedius muscles in the resting supine position at the center and anterior surface of the femur. The results showed a significant increase in knee extension strength and anterior thigh muscle thickness and a significant decrease in femoris quadriceps muscle brightness (61.0 ± 14.9 vs. 55.2 ± 14.8 a.u., p = 0.049) after 3 months of training compared to before training. The results suggest that KAATSU training is effective not only for improving skeletal muscle mass but also muscle quality index.