Secondary sarcopenia assessed by computed tomography can predict hospitalization for heart failure in adults with Fontan circulation

Abstract

Sarcopenia is a loss of muscle mass and function [1]. This phenomenon occurs not only in elderly people but also in patients with chronic illnesses such as, chronic heart failure (HF), liver dysfunction, and kidney dysfunction [1-5], which is called secondary sarcopenia. Possible explanations for sarcopenia include an abnormal energy metabolism coupled with mitochondrial dysfunction as well as a change in the structure of the myofibers, malnutrition, systemic inflammation, and oxidative stress [6][7][8][9].Recent studies have reported that secondary sarcopenia is not rare in adults with congenital heart disease (CHD) [10,11]. Sarcopenia is one of the important predictors of HF in non-CHD [12][13][14]; whereas, it remains unclear whether sarcopenia is also relevant to prognosis in adults with CHD. In particular, skeletal muscle function is important in Fontan circulation because a passive blood flow in a Fontan route can be maintained by both skeletal muscle pumping and the change of intrapleural pressure (ventilatory pumping) [15][16][17]. However, it is challenging to measure the entire skeletal muscle mass; until now, dual energy X-ray absorptiometry or bioelectrical impedance analysis (BIA) has been used to measure it [1,2]. The former method needs special equipment, and the latter is not available to patients after pacemaker implantation. The biggest issue in adults with Fontan circulation is that most patients have already undergone pacemaker implantation; therefore,

Somatic growth in single ventricle patients: A systematic review and meta‐analysis

“…Alternative measures of somatic growth and body composition such as subcutaneous fat, triceps skinfold measurements, muscle mass, head circumference, bioelectrical impedance and whole‐body dual X‐ray absorptiometry were beyond the scope of this review, but have been investigated in the single ventricle population by others. 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 These studies have shown sarcopenia and deficits in bone density and structure to be major components of body composition in Fontan patients. Second, selection bias is plausible because most participants were by definition considered good candidates for the Fontan procedure; these data therefore assume that a thorough clinical assessment has preceded the decision to pursue the Fontan trajectory and may not be representative of the overall single ventricle population.…”

“…Alternative measures of somatic growth and body composition such as subcutaneous fat, triceps skinfold measurements, muscle mass, head circumference, bioelectrical impedance and whole-body dual X-ray absorptiometry were beyond the scope of this review, but have been investigated in the single ventricle population by others. [59][60][61][62][63][64][65][66] These studies have shown sarcopenia and deficits in bone density and structure to be major components of body composition in Fontan patients.…”

Cardiovascular Imaging-Derived Skeletal Muscle Mass Correlates With Fitness and Survival in Patients With Univentricular Circulation

“…In a retrospective study of 154 patients with Fontan circulation, a lower volume of the large lumbar muscle on an abdominal CT scan was associated with a higher risk of hospitalization for heart failure [ 12 ]. Oh et al found a lower likelihood of postoperative complications and prolonged intensive care bed stays after Fontan surgery in patients with a higher SMI (Th4) detected on preoperative CT scans [ 13 ].…”

Frailty alone and interactively with obesity predicts heart failure: Kuopio Ischaemic Heart Disease Risk Factor Study

“…[39][40][41] Secondary sarcopenia has been implicated as both a cause and consequence of HF. Secondary sarcopenia is one of the important predictors of HF in non-chronic heart disease 42 and has a negative impact on the prognosis of HF in this population. Whereas it remains unclear how biological mechanisms aggravate sarcopenia in older adults with HF.…”