Muscle wasting as an independent predictor of survival in patients with chronic heart failure

Haehling, Stephan von; Macedo, Tania Garfias; Valentová, Miroslava; Anker, Markus S.; Ebner, Nicole; Bekfani, Tarek; Haarmann, Helge; Schefold, Joerg C.; Lainščak, Mitja; Cleland, John G.F.; Doehner, Wolfram; Hasenfuß, Gerd; Anker, Stefan D.

doi:10.1002/jcsm.12603

Cited by 89 publications

(87 citation statements)

References 39 publications

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“…Our recent study reported that presence of osteoporosis assessed during hospital stay is an independent predictor of adverse events after discharge and fat mass index was closely associated with the extent of osteoporosis [ 53 ]. Result of a recent study showed that muscle wasting is an independent predictor of mortality in stable ambulatory HF patients [ 54 ]. Taken together with findings of the present study, muscle wasting may be an early marker for HF progression, whereas reduction in fat mass and bone mineral content may serve as a marker of cachexia.…”

Section: Discussionmentioning

confidence: 99%

High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

et al. 2021

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Background Although high body mass index (BMI) is a risk factor of heart failure (HF), HF patients with a higher BMI had a lower mortality rate than that in HF patients with normal or lower BMI, a phenomenon that has been termed the “obesity paradox”. However, the relationship between body composition, i.e., fat or muscle mass, and clinical outcome in HF remains unclear. Methods We retrospectively analyzed data for 198 consecutive HF patients (76 years of age; males, 49%). Patients who were admitted to our institute for diagnosis and management of HF and received a dual-energy X-ray absorptiometry scan were included regardless of left ventricular ejection fraction (LVEF) categories. Muscle wasting was defined as appendicular skeletal muscle mass index < 7.0 kg/m2 in males and < 5.4 kg/m2 in females. Increased percent body fat mass (increased FM) was defined as percent body fat > 25% in males and > 30% in females. Results The median age of the patients was 76 years (interquartile range [IQR], 67–82 years) and 49% of them were male. The median LVEF was 47% (IQR, 33–63%) and 33% of the patients had heart failure with reduced ejection fraction. Increased FM and muscle wasting were observed in 58 and 67% of the enrolled patients, respectively. During a 180-day follow-up period, 32 patients (16%) had cardiac events defined as cardiac death or readmission by worsening HF or arrhythmia. Kaplan-Meier survival curves showed that patients with increased FM had a lower cardiac event rate than did patients without increased FM (11.4% vs. 22.6%, p = 0.03). Kaplan-Meier curves of cardiac event rates did not differ between patients with and those without muscle wasting (16.5% vs. 15.4%, p = 0.93). In multivariate Cox regression analyses, increased FM was independently associated with lower cardiac event rates (hazard ratio: 0.45, 95% confidence interval: 0.22–0.93) after adjustment for age, sex, diabetes, muscle wasting, and renal function. Conclusions High percent body fat mass is associated with lower risk of short-term cardiac events in HF patients.

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Section: Discussionmentioning

confidence: 99%

High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

et al. 2021

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“…Vice versa, cardiac dysfunction itself promotes skeletal muscle wasting, a complication known as cardiac cachexia. Furthermore, cardiac cachexia is an independent predictor of survival in chronic heart failure patients 5 in experimental models [6][7][8][9] and in up to 19.5% of heart failure patients, particularly those with reduced ejection fraction 10 .…”

Section: Introductionmentioning

confidence: 99%

Understanding the common mechanisms of heart and skeletal muscle wasting in cancer cachexia

et al. 2021

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Cachexia is a severe complication of cancer that adversely affects the course of the disease, with currently no effective treatments. It is characterized by a progressive atrophy of skeletal muscle and adipose tissue, resulting in weight loss, a reduced quality of life, and a shortened life expectancy. Although the cachectic condition primarily affects the skeletal muscle, a tissue that accounts for ~40% of total body weight, cachexia is considered a multi-organ disease that involves different tissues and organs, among which the cardiac muscle stands out for its relevance. Patients with cancer often experience severe cardiac abnormalities and manifest symptoms that are indicative of chronic heart failure, including fatigue, shortness of breath, and impaired exercise tolerance. Furthermore, cardiovascular complications are among the major causes of death in cancer patients who experienced cachexia. The lack of effective treatments for cancer cachexia underscores the need to improve our understanding of the underlying mechanisms. Increasing evidence links the wasting of the cardiac and skeletal muscles to metabolic alterations, primarily increased energy expenditure, and to increased proteolysis, ensuing from activation of the major proteolytic machineries of the cell, including ubiquitin-dependent proteolysis and autophagy. This review aims at providing an overview of the key mechanisms of cancer cachexia, with a major focus on those that are shared by the skeletal and cardiac muscles.

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“…On the other hand, it has been known for decades that skeletal muscle structural and functional alterations are often associated with chronic heart failure (CHF) in noncachectic patients [ 123 ]. Muscle wasting not only strongly impairs CHF patients’ quality of life by impacting their daily activities through reduced physical capacity but has been also recently acknowledged as an aggravating comorbidity [ 124 ] and an independent predictor of survival [ 125 ]. These findings are driving a renewed attention from the scientific and clinical community, and technical advances and increased knowledge about muscle physiology have helped in opening new perspectives and identifying fat tissue as an important mediator in the cardiac–skeletal muscle crosstalk [ 126 , 127 ].…”

Section: Crosstalk Between Skeletal Muscle and Other Organs In Cacmentioning

confidence: 99%

A Pound of Flesh: What Cachexia Is and What It Is Not

et al. 2021

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Body weight loss, mostly due to the wasting of skeletal muscle and adipose tissue, is the hallmark of the so-called cachexia syndrome. Cachexia is associated with several acute and chronic disease states such as cancer, chronic obstructive pulmonary disease (COPD), heart and kidney failure, and acquired and autoimmune diseases and also pharmacological treatments such as chemotherapy. The clinical relevance of cachexia and its impact on patients’ quality of life has been neglected for decades. Only recently did the international community agree upon a definition of the term cachexia, and we are still awaiting the standardization of markers and tests for the diagnosis and staging of cancer-related cachexia. In this review, we discuss cachexia, considering the evolving use of the term for diagnostic purposes and the implications it has for clinical biomarkers, to provide a comprehensive overview of its biology and clinical management. Advances and tools developed so far for the in vitro testing of cachexia and drug screening will be described. We will also evaluate the nomenclature of different forms of muscle wasting and degeneration and discuss features that distinguish cachexia from other forms of muscle wasting in the context of different conditions.

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Muscle wasting as an independent predictor of survival in patients with chronic heart failure

Cited by 89 publications

References 39 publications

High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

Understanding the common mechanisms of heart and skeletal muscle wasting in cancer cachexia

A Pound of Flesh: What Cachexia Is and What It Is Not

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