Prognostic value of cardio-hepatic-skeletal muscle syndrome in patients with heart failure

Abstract

Although heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). In the multiple regression analysis, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (all P < 0.001). One hundred thirty deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62–3.04). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.

Spot Urinary Creatinine Concentration in Patients with Chronic Heart Failure Identifies a Distinct Muscle-Wasting Phenotype with a Strikingly Different Risk of Mortality

“…In HF patients, especially during exercise [33], dietary provision [34], gut absorption [35] and effective transport of creatine to hypoperfused muscles might be impaired. Additionally, availability of creatine may be hampered by low serum levels of L-arginine, glycine and methionine [36], as well as poor metabolic function of kidneys and the liver; all these abnormalities are frequently encountered in HF [37]. Thus, decreased creatine pool, already shown in HF [38], may be responsible for both reduced output of creatinine in urine and energetic constrains to the heart and SM, finally resulting in worse prognosis.…”