Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting

Abstract

Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.

Post-COVID-19 acute sarcopenia: physiopathology and management

“…On the other hand, the COVID-19 may develop in a patient already burdened with cardiovascular disease and thus prone to the development of sarcopenia [75]. In such case the pro-sarcopenic effects of COVID-19 would act synergistically with the burden already present [76].…”

Biomarkers and the quadriceps femoris muscle architecture assessed by ultrasound in older adults with heart failure with preserved ejection fraction: a cross-sectional study

“…This way, pathological values can be distilled, cut-off points can be established, and correlations with the other aspects of sarcopenia-strength and function [ 17 ]. Many different mechanisms related to HF potentially lead to sarcopenia, such as hyper-activation of the sympathetic system, systemic inflammation, elevated oxidative processes, higher apoptotic activity or reduced release of the skeletal muscle [ 9 , 10 , 43 ]. On the other hand, sarcopenia induces impaired muscle contraction and metabolic and endocrine abnormalities that may contribute to cardiovascular remodelling and dysfunction and the development of HFpEF [ 45 ].…”

“…Many factors related to HF potentially lead to sarcopenia, like hormonal changes, physical inactivity, oxidative stress or inflammation [ 9 , 10 ]. Sarcopenia could reduce the aerobic capacity and the quality of life of patients with HFpEF [ 8 ].…”

Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure

“…However, the existing criteria for the diagnosis of muscle wasting or cardiac cachexia are not strictly precise and they are still debated [21,24,27]. Therefore, these distinct clinical entities frequently overlap and are recognized interchangeably by clinicians [28]. In the current understanding of cachexia and skeletal muscle wasting in HF, under-nutrition plays a central role [29].…”