The wasting continuum in heart failure: from sarcopenia to cachexia

Abstract

Conference on 'Nutrition and age-related muscle loss, sarcopenia and cachexia' Symposium 2: Mechanisms for loss of muscle mass, strength and clinical measurement of malnutrition and cachexiaThe wasting continuum in heart failure: from sarcopenia to cachexiaStephan von Haehling Sarcopenia (muscle wasting) and cachexia share some pathophysiological aspects.Sarcopenia affects approximately 20 %, cachexia <10 % of ambulatory patients with heart failure (HF). Whilst sarcopenia means loss of skeletal muscle mass and strength that predominantly affects postural rather than non-postural muscles, cachexia means loss of muscle and fat tissue that leads to weight loss. The wasting continuum in HF implies that skeletal muscle is lost earlier than fat tissue and may lead from sarcopenia to cachexia. Both tissues require conservation, and therapies that stop the wasting process have tremendous therapeutic appeal. The present paper reviews the pathophysiology of muscle and fat wasting in HF and discusses potential treatments, including exercise training, appetite stimulants, essential amino acids, growth hormone, testosterone, electrical muscle stimulation, ghrelin and its analogues, ghrelin receptor agonists and myostatin antibodies.

Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life

“…These changes include a switch in the muscle fibers types from fast type II to the slow type I fibers and a reduction in capillary density (33,34). This may result in reduced physical performance.…”

“…The pathophysiology of muscle wasting in patients with chronic diseases is not entirely clear yet. Signaling pathways may be different in healthy aging and in patients with chronic diseases with higher inflammatory load and thus more pronounced proteasome activity in patients with chronic disease, thus serving as a basis for active myofibril degeneration (34,39). Indeed, one of the hypotheses holds that inflammatory processes, which accompany many chronic diseases, may lead to metabolic changes.…”

Preoperative Pectoralis Muscle Quantity and Attenuation by Computed Tomography Are Novel and Powerful Predictors of Mortality After Left Ventricular Assist Device Implantation

“…21,22 Although frailty lacks a consensus definition, it has been shown to be an important prognostic marker in LVAD therapy. [22][23][24] It is not surprising that low muscle mass, which correlates with frailty, was strongly associated with mortality in this data set.…”

Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex‐DHF pilot study

“…have previously suggested that repeated administration of ghrelin may improve left ventricular function, exercise capacity, and reduce muscle wasting in patients with HF. Because the relevance of sarcopenia in the clinical picture of HF22 is growing and approximately 20% of HF patients with an average age of nearly 70 years may meet the criteria for diagnosing sarcopenia,23 ghrelin may be an interesting treatment strategy to tackle the wasting continuum in HF 24…”