Sympatho-Vagal Imbalance is Associated with Sarcopenia in Male Patients with Heart Failure

Abstract

Background Resting sympathetic hyperactivity and impaired parasympathetic reactivation after exercise have been described in patients with heart failure (HF). However, the association of these autonomic changes in patients with HF and sarcopenia is unknown. Objective The aim of this study was to evaluate the impact of autonomic modulation on sarcopenia in male patients with HF. Methods We enrolled 116 male patients with HF and left ventricular ejection fraction < 40%. All patients underwent a maximal cardiopulmonary exercise testing. Maximal heart rate was recorded and delta heart rate recovery (∆HRR) was assessed at 1 st and 2 nd minutes after exercise. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography. Dual-energy X-ray absorptiometry was used to measure body composition and sarcopenia was defined by the sum of appendicular lean muscle mass (ALM) divided by height in meters squared and handgrip strength. Results Sarcopenia was identified in 33 patients (28%). Patients with sarcopenia had higher MSNA than those without (47 [41-52] vs. 40 [34-48] bursts/min, p = 0.028). Sarcopenic patients showed lower ∆HRR at 1 st (15 [10-21] vs. 22 [16-30] beats/min, p < 0.001) and 2 nd min (25 [19-39] vs. 35 [24-48] beats/min, p = 0.017) than non-sarcopenic. There was a positive correlation between ALM and ∆HRR at 1 st (r = 0.26, p = 0.008) and 2 nd min (r = 0.25, p = 0.012). We observed a negative correlation between ALM and MSNA (r = -0.29, p = 0.003). Conclusion Sympatho-vagal imbalance seems to be associated with sarcopenia in male patients with HF. These results highlight the importance of a therapeutic approach in patients with muscle wasting and increased peripheral sympathetic outflow.

Discriminating sarcopenia in overweight/obese male patients with heart failure: the influence of body mass index

“…It is well recognized as an independent marker of worse prognosis in patients with HF, 2 and has been related to reduced functional capacity and sympathovagal imbalance. 17,18 The last revised European consensus about sarcopenia states that the cut-off point for sarcopenia must be lower than 7.0 kg/m 2 for men using Baumgartner's method. 1 In our study, using the lower 20th percentile of Baumgartner's method to define sarcopenia, we found a similar cut-off of 7.03 kg/m 2 .…”

Heart and Skeletal Muscles: Linked by Autonomic Nervous System

“…Based on their current study by Fonseca et al, 5 we can speculate that if they have used other assessment methods, like the 4-second exercise test, 6,7 - a very specific one for assessing cardiac vagal activity - and handgrip strength relative to body weight or maximal muscle power 8 or even a simple functional test like the sitting-rising test, 9 all of them, more specific to assess dynapenia, a likely clinically more relevant issue than sarcopenia, 10,11 they could have found additional discriminative values.…”

“…They have identified sarcopenia in 33 (28%) of HFrEF patients and their results indicated that these patients had significantly distinct results to the ANS variables assessed when compared as to the group of patients without sarcopenia. 5 Moreover, they found a significant although quite modest correlation (r = -0.29) between appendicular muscle mass and muscle sympathetic nerve activity. Looking in more details their results, it is possible to note that there is a considerable overlapping between the results of HFrEF patients with and without sarcopenia, which may diminish the clinical value.…”

“…In a Brazilian and German collaborative research study, Fonseca et al 5 analyzed data from 116 male patients with heart failure with reduced ejection fraction (HFrEF) that were submitted to a maximal cycling cardiopulmonary exercise testing using a ramp protocol. In addition, using a microneurography technique, muscle sympathetic nerve activity was directly recorded from the peroneal nerve and parasympathetic activity was estimated by the magnitude of heart rate decay in the first two minutes after the maximal cycling exercise test.…”

“…In acknowledging that this study showed an association between cardiac ANS dysfunction and heart and skeletal muscle abnormalities and knowing that regular aerobic and resistance exercise improves cardiac ANS modulation, including reducing the risk of ventricular fibrillation on the occurrence of a myocardial infarction, 12 and are strongly recommended as part of the medical treatment of patients with sarcopenia and for those with HFpEF; 13 it is quite motivating to think about an expected next step in research: a randomized controlled trial with exercise training intervention. Such study would assess if the ANS dysfunction reported by Fonseca et al 5 is subject to reversal, and if so, how this would improve quality of life and other major health outcomes in patients with HFpEF.…”