Muscle Wasting in Patients With Chronic Heart Failure
Muscle Wasting in Patients With Chronic Heart Failure
Evaluation of: Fülster S, Tacke M, Sandek A et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating comorbidities aggravating heart failure (SICA-HF). Eur. Heart J. 34(7), 512–519 (2013). Muscle atrophy of the lower limbs is a comorbidity that can develop in advanced stages of chronic heart failure (HF). The article by Fülster et al. prospectively examined the association of muscle mass volume and muscle strength, gait speed, walking distance and treadmill performance in 200 stable HF patients. Muscle wasting was legitimately defined as the appendicular muscle mass two standard deviations below the mean of a healthy reference group. Muscle wasting was detected in 39 (19.5%) patients. Patients with muscle atrophy had significantly lower values for muscle strength, as well as lower total peak oxygen consumption (1173 ± 433 vs 1622 ± 456 ml/min), lower exercise time (7.7 ± 3.8 vs 10.2 ± 2.0 min; both p < 0.001) and lower left ventricular ejection fraction (p = 0.05). In addition, the distance walked and gait speed were also lower in patients with muscle wasting than those without (p < 0.05). Logistic regression analyses revealed that muscle wasting was independently associated with reduced peak oxygen consumption after adjustment for cofounders. These findings suggest that skeletal muscle wasting is common in chronic HF patients and is associated with worse exercise capacity and reduced left ventricular ejection fraction.
Heart failure (HF) is a clinical syndrome characterized by diverse metabolic disturbances, many of which adversely affect muscle and fat metabolism, thereby ultimately leading to cachexia. In particular, skeletal muscle atrophy is prevalent in chronic HF patients. A loss of leg muscle mass volume is an initial anthropometric characteristic in the natural course of chronic HF. Along with the progression to cachectic status, there was further loss of muscle mass in the four limbs. Cachectic patients show greater muscle weakness than noncachectic patients, and they have a 16% reduction of quadricep strength per unit muscle.
This article reviews the paper by Fülster et al., demonstrating that 19.5% of stable HF patients had complications with muscle wasting. They showed that HF patients with muscle wasting had reduced exercise capacity and muscle strength, and advanced disease compared with those without. The findings convincingly suggest that reduced skeletal muscle mass is greatly associated with advanced chronic HF.
Abstract and Introduction
Abstract
Evaluation of: Fülster S, Tacke M, Sandek A et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating comorbidities aggravating heart failure (SICA-HF). Eur. Heart J. 34(7), 512–519 (2013). Muscle atrophy of the lower limbs is a comorbidity that can develop in advanced stages of chronic heart failure (HF). The article by Fülster et al. prospectively examined the association of muscle mass volume and muscle strength, gait speed, walking distance and treadmill performance in 200 stable HF patients. Muscle wasting was legitimately defined as the appendicular muscle mass two standard deviations below the mean of a healthy reference group. Muscle wasting was detected in 39 (19.5%) patients. Patients with muscle atrophy had significantly lower values for muscle strength, as well as lower total peak oxygen consumption (1173 ± 433 vs 1622 ± 456 ml/min), lower exercise time (7.7 ± 3.8 vs 10.2 ± 2.0 min; both p < 0.001) and lower left ventricular ejection fraction (p = 0.05). In addition, the distance walked and gait speed were also lower in patients with muscle wasting than those without (p < 0.05). Logistic regression analyses revealed that muscle wasting was independently associated with reduced peak oxygen consumption after adjustment for cofounders. These findings suggest that skeletal muscle wasting is common in chronic HF patients and is associated with worse exercise capacity and reduced left ventricular ejection fraction.
Introduction
Heart failure (HF) is a clinical syndrome characterized by diverse metabolic disturbances, many of which adversely affect muscle and fat metabolism, thereby ultimately leading to cachexia. In particular, skeletal muscle atrophy is prevalent in chronic HF patients. A loss of leg muscle mass volume is an initial anthropometric characteristic in the natural course of chronic HF. Along with the progression to cachectic status, there was further loss of muscle mass in the four limbs. Cachectic patients show greater muscle weakness than noncachectic patients, and they have a 16% reduction of quadricep strength per unit muscle.
This article reviews the paper by Fülster et al., demonstrating that 19.5% of stable HF patients had complications with muscle wasting. They showed that HF patients with muscle wasting had reduced exercise capacity and muscle strength, and advanced disease compared with those without. The findings convincingly suggest that reduced skeletal muscle mass is greatly associated with advanced chronic HF.
