Body composition, appetite-related hormones, adipocytokines, and heart failure in adult patients with congenital heart disease: A preliminary study

Shiina, Yumi; Murakami, Tomoaki; Matsumoto, Noriko; Okamura, Daisuke; Takahashi, Yuta; Nishihata, Yosuke; Komiyama, Nobuyuki; Niwa, Koichiro

doi:10.1111/chd.12555

Cited by 14 publications

(17 citation statements)

References 32 publications

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“…The decreased ghrelin levels following the diagnosis of DCM are consistent with previous studies on HF of different etiology [23]. Ghrelin has a favorable effect on cardiovascular function and has been considered as a potentially therapeutic hormone [39]. Further studies should address factors associated with the response to ghrelin such as to directly assess how the etiology of heart failure impacts on the downregulation of GHSR and to identify if inflammation or other factors may modulate GHSR expression and ghrelin sensitivity, in a way to reverse ghrelin resistance and to restore its protective effects on the myocardium.…”

Section: Discussionsupporting

confidence: 85%

Ghrelin Derangements in Idiopathic Dilated Cardiomyopathy: Impact of Myocardial Disease Duration and Left Ventricular Ejection Fraction

Aleksova

Beltrami

Bevilacqua

et al. 2019

JCM

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Background: Ghrelin may exert positive effects on cardiac structure and function in heart failure (HF) patients. Methods: We assessed ghrelin levels in 266 dilated cardiomyopathy (DCM) patients and in 200 age, gender and body mass index (BMI) matched controls. Further, we evaluated the expression of ghrelin and growth hormone secretagogue-receptor (GHSR) in the myocardium of 41 DCM patients and in 11 controls. Results: DCM patients had significantly lower levels of total, acylated and unacylated ghrelin when compared to controls (p < 0.05 for all). In controls, we observed a negative correlation of ghrelin with age, male gender and BMI. These correlations were lost in the DCM group, except for male gender. Total ghrelin was higher in patients with more recent diagnosis when compared to patients with longer duration of the DCM (p = 0.033). Further, total ghrelin was higher in patients with lower left ventricular systolic function (<40% LVEF, vs. 40% ≤ LVEF < 49% vs. LVEF ≥ 50%: 480.8, vs. 429.7, vs. 329.5 pg/mL, respectively, p = 0.05). Ghrelin prepropeptide was expressed more in DCM patients than in controls (p = 0.0293) while GHSR was expressed less in DCM patients (p < 0.001). Furthermore, ghrelin showed an inverse correlation with its receptor (= −0.406, p = 0.009), and this receptor showed a significant inverse correlation with Interleukin-1 (= −0.422, p = 0.0103). Conclusion: DCM duration and severity are accompanied by alterations in the ghrelin–GHSR system.

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Section: Discussionsupporting

confidence: 85%

Ghrelin Derangements in Idiopathic Dilated Cardiomyopathy: Impact of Myocardial Disease Duration and Left Ventricular Ejection Fraction

Aleksova

Beltrami

Bevilacqua

et al. 2019

JCM

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“…20 Shiina et al also found that Fontan patients have reduced muscle mass when compared to controls, but their analyses were not sex-stratified. 21 This renders it difficult to interpret their results and correlate them with our findings, since it is known that the muscular composition of men and women is very different.…”

mentioning

confidence: 71%

Sarcopenia in Fontan patients: a sign of frailty-associated premature ageing?

et al. 2021

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On November 10, 1942, after winning the battle of Alamein, Winston Churchill delivered these famous words: "Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."Adults living with CHD are a growing population, as they are now surviving into adulthood and even reaching geriatric ages thanks to the emergence of surgical and medical innovations. 1 In all adults with CHD, the fastest-growing population is the one with complex congenital lesions. 1 Fontan patients are among the most resource-intensive populations from a health service perspective. They experience multiple extracardiac complications that are mainly related to sustained decreased cardiac output and increased systemic venous pressure. 2 This means that Fontan patients are living with a lifespan state of compensated or decompensated heart failure. 2 The functional consequences of their singular cardiovascular physiology have been expressed as both a reduced life expectancy when compared to other CHD population 3 and a decreased exercise capacity. 4 Moreover, skeletal muscle strength has been shown to be similar to that of patients with advanced heart failure, 5 since they have increased adiposity and, as shown by Cordina et al., Fontan-associated myopenia. 6 The advent of the Fontan operation has certainly improved outcomes for patients with univentricular heart, but given the ensuing complications, treating physicians feel this is "the end of the beginning," to use Churchill's words.Psoas muscle area, an indicator of sarcopenia, has proven to be an important marker of worse cardiovascular outcomes and of increased risk of mortality in patients with long-standing heart failure and increased cardiovascular burden. [7][8][9][10][11] It has also been shown to be correlated with indicators of physical frailty such as low handgrip strength and short physical performance battery. 12 Frailty is a broad multidimensional syndrome that reflects a patient's vulnerability. It encompasses multiple clinical elements such as muscle mass, strength, malnutrition, and functional performance. 13 Sarcopenia is therefore a crucial element in the assessment of frailty. We hypothesised that Fontan patients, despite their young age, exhibit sarcopenia resembling that more often seen in elderly patients with cardiovascular comorbidities rather than in healthy agematched controls.At the McGill Adult Unit for Congenital Heart Disease (MAUDE clinic, Montreal, Canada), a total of 67 patients with Fontan are actively followed. Multiple imaging modalities are used as part of the routine screening for Fontan-associated liver disease, including abdominal ultrasound, CT, and magnetic resonance. In this setting, 17 out of 67 Fontan patients had a CT of the abdomen performed and thus were included in the study. The psoas muscle areas were measured on the CT scan using the validated web-based software Coreslicer.com. 14 Measurements were done in the axial plane, at the highest level of the L4 vertebrae. There is no gold standard numb...

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“…Fontan associated myopenia, defined as a lean muscle mass Z-score of −2 or lower, is present in 39% of Fontan patients ( 63 ). Bio-impedance measurements and MRI-derived muscle mass estimations—which are more easily obtained estimations of muscle mass- are also abnormal for Fontan patients ( 64 – 66 ). No studies directly compared these methods of lean muscle mass estimation to current gold standards.…”

Section: Resultsmentioning

confidence: 99%

“…Shiina et al in a prospective study of 46 adult Fontan patients, showed that in the Fontan patient group plasma ghrelin levels, a hormone primarily related to increased appetite, were lower than those in controls ( P < 0.05) ( 66 ). Ghrelin is an orexigenic hormone.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, it has a favorable effect on cardiovascular function (decreases vascular resistance and increases cardiac output). It is seen as a potential therapeutic target in congestive heart failure ( 66 ). In Fontan patients, the decreased ghrelin levels may contribute to cardiovascular dysfunction, growth stunting and metabolic abnormalities.…”

Section: Resultsmentioning

confidence: 99%

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Fontan Circulation Associated Organ Abnormalities Beyond the Heart, Lungs, Liver, and Gut: A Systematic Review

Ritmeester

Veger

Ven

et al. 2022

Front. Cardiovasc. Med.

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IntroductionPatients with a Fontan circulation are at risk for sequelae of Fontan physiology during follow-up. Fontan physiology affects all organ systems and an overview of end-organ damage is needed.MethodsWe performed a systematic review of abnormalities in multiple organ systems for patients with a longstanding Fontan circulation. We searched online databases for articles describing abnormalities in multiple organ systems. Cardio-pulmonary abnormalities, protein losing enteropathy, and Fontan associated liver disease have already extensively been described and were excluded from this systematic review.ResultsOur search returned 5,704 unique articles. After screening, we found 111 articles relating to multiple organ systems. We found abnormalities in, among others, the nervous system, pituitary, kidneys, and musculoskeletal system. Pituitary edema—relating to the unique pituitary vasculature- may affect the thyroid axis. Renal dysfunction is common. Creatinine based renal function estimates may be inappropriate due to myopenia. Both lean muscle mass and bone mineral density are decreased. These abnormalities in multiple organ systems may be related to Fontan physiology, cyanosis, iatrogenic factors, or lifestyle.ConclusionsHealth care providers should be vigilant for hypothyroidism, visual or hearing deficits, and sleep disordered breathing in Fontan patients. We recommend including cystatin C for assessment of renal function. This review may aid health care providers and guide future research.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232461, PROSPERO, identifier: CRD42021232461.

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Body composition, appetite-related hormones, adipocytokines, and heart failure in adult patients with congenital heart disease: A preliminary study

Cited by 14 publications

References 32 publications

Ghrelin Derangements in Idiopathic Dilated Cardiomyopathy: Impact of Myocardial Disease Duration and Left Ventricular Ejection Fraction

Ghrelin Derangements in Idiopathic Dilated Cardiomyopathy: Impact of Myocardial Disease Duration and Left Ventricular Ejection Fraction

Sarcopenia in Fontan patients: a sign of frailty-associated premature ageing?

Fontan Circulation Associated Organ Abnormalities Beyond the Heart, Lungs, Liver, and Gut: A Systematic Review

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