Muscle Wasting and Sarcopenia in Heart Failure—The Current State of Science

Abstract

Sarcopenia is primarily characterized by skeletal muscle disturbances such as loss of muscle mass, quality, strength, and physical performance. It is commonly seen in elderly patients with chronic diseases. The prevalence of sarcopenia in chronic heart failure (HF) patients amounts to up to 20% and may progress into cardiac cachexia. Muscle wasting is a strong predictor of frailty and reduced survival in HF patients. Despite many different techniques and clinical tests, there is still no broadly available gold standard for the diagnosis of sarcopenia. Resistance exercise and nutritional supplementation represent the currently most used strategies against wasting disorders. Ongoing research is investigating skeletal muscle mitochondrial dysfunction as a new possible target for pharmacological compounds. Novel agents such as synthetic ghrelin and selective androgen receptor modulators (SARMs) seem promising in counteracting muscle abnormalities but their effectiveness in HF patients has not been assessed yet. In the last decades, many advances have been accomplished but sarcopenia remains an underdiagnosed pathology and more efforts are needed to find an efficacious therapeutic plan. The purpose of this review is to illustrate the current knowledge in terms of pathogenesis, diagnosis, and treatment of sarcopenia in order to provide a better understanding of wasting disorders occurring in chronic heart failure.

Heart failure in the last year: progress and perspective

“…Further common co‐morbidities associated with HF are chronic kidney disease, 52,53 chronic obstructive pulmonary disease, 54 central nervous system abnormalities, 55,56 sleep disordered breathing, 57 iron deficiency, cancer, 58–61 cachexia, 62–64 muscle wasting (sarcopenia), 51,65–69 and frailty 70–73 . The prevalence of frailty is increased in HF and is associated with worse outcome 74 .…”

Role of Cachexia and Fragility in the Patient Candidate for Cardiac Surgery

“…There are numerous factors responsible for this muscle loss: the aging process, genetic susceptibility, environmental factors, such as suboptimal diet, prolonged bed rest, sedentary lifestyle, chronic diseases and drugs [ 9 , 10 ]. In most cases the etiology of sarcopenia is multifactorial and sarcopenia is considered PRIMARY (age-related) when the only obvious cause is aging [ 11 , 12 , 13 , 14 ]. Malnutrition plays a key role in the pathogenesis of sarcopenia and frailty.…”

The other striated muscle: The role of sarcopenia in older persons with heart failure

“…17,18 Pharmacotherapies, such as ghrelin analogues and selective androgen receptor modulators, are also currently under investigation as potential treatments of sarcopenia in HF (Figure 1). 19 T In conclusion, Attaway and colleagues provide novel and valuable information regarding the importance of muscle loss to outcomes in patients hospitalized with HF. Such data are critical to broaden the therapeutic focus in HF from solely on cardiac tissue to also include coordinated dysfunction throughout the body, and particularly on skeletal muscle.…”