Sarcopenia in Patients with End-Stage Cardiac Failure Requiring Ventricular Assist Device or Heart Transplantation

Abstract

Sarcopenia has been defined as the age-related reduced skeletal muscle mass, strength, and physical capacity and is frequently associated with serious complications in patients with heart failure (HF). However, when HF progressed to end-stage HF requiring advanced therapies, such as heart transplantation (HTx) and implantation of left ventricular assist device (LVAD), an even higher prevalence of sarcopenia has been reported in younger patients with end-stage HF than elderly patients with less advanced HF. Many literatures have reported that sarcopenia is greatly associated with high rates of morbidity and mortality after HTx and LVAD implantation. Therefore, therapeutic interventions to prevent and reverse sarcopenia, such as cardiac rehabilitation and nutrition supplementation, are important in patients with end-stage HF prior to HTx and LVAD implantation. Although moderate or severe sarcopenia is a contraindication for HTx, the patients who can recover from sarcopenia after LVAD implantation would be considered eligible for HTx. Then, therapeutic options to reverse sarcopenia in patients supported with LVAD are also important to improve patient prognosis after LVAD implantation. In this review, the impacts of sarcopenia on prognosis after LVAD implantation and HTx and vice versa were summarized and therapeutic interventions to reverse sarcopenia before and after LVAD implantation are discussed.