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

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Title: Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life
Authors: Bekfani, T
Pellicori, P
Morris, DA
Ebner, N
Valentova, M
Steinbeck, L
Wachter, R
Elsner, S
Sliziuk, V
Schefold, JC
Sandek, A
Doehner, W
Cleland, JGF
Lainscak, M
Anker, SD
Von Haehlin, S
Item Type: Journal Article
Abstract: Background To describe the prevalence of sarcopenia in ambulatory patients with heart failure with preserved ejection fraction (HFpEF) and its relation to reduced exercise capacity, muscle strength, and quality of life (QoL). Methods and results A total of 117 symptomatic outpatients with HFpEF were prospectively enrolled in Germany, England, and Slovenia as part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Appendicular skeletal muscle (ASM) mass (the sum of muscle mass in both arms and legs) was assessed by DEXA. Echocardiography, 6-minute walk testing (6-MWT), muscle strength assessment, spiroergometry and QoL evaluation using EQ-5D Questionnaire were performed. Sarcopenia was defined as ASM 2 standard deviations below the mean of a healthy reference group aged 18–40 years. Patients were divided into 3 groups according to the E/e′ value: ≤ 8, 9–14, and ≥ 15. Sarcopenia was detected in 19.7% of all patients. These patients performed worse during 6-MWT (404 ± 116 vs. 307 ± 145 m, p = 0.003) and showed lower absolute peak oxygen consumption (1579 ± 474 vs. 1211 ± 442 mL/min, p < 0.05). Both ASM and muscle strength were lowest in patients with E/e′ > 15 (p < 0.05). Higher values of muscle strength/ASM were associated with a better QoL (r = 0.5, p < 0.0005). Logistic regression showed ASM to be independently associated with reduced distance walked during the 6-MWT adjusted for NYHA, height, left atrium diameter, ferritin and forced expiratory volume in 1 s (FEV1) (odds ratio 1.2, p = 0.02). Conclusion Sarcopenia affects a clinically relevant proportion of patients with HFpEF. Low ASM is strongly linked to reduced muscle strength, exercise capacity and QoL in these patients.
Issue Date: 14-Jul-2016
Date of Acceptance: 8-Jul-2016
ISSN: 1874-1754
Publisher: Elsevier
Start Page: 41
End Page: 46
Journal / Book Title: International Journal of Cardiology
Volume: 222
Copyright Statement: © 2016, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Keywords: Exercise capacity
Heart failure with preserved ejection fraction
Muscle wasting
Quality of life
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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