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Imamura Y, Suzuki A, Kamishima K, Suzuki K, Yamaguchi J. Prognostic factors in patients with heart failure and sarcopenia: an observational retrospective study. Egypt Heart J 2024; 76:52. [PMID: 38683441 PMCID: PMC11058133 DOI: 10.1186/s43044-024-00484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Heart failure (HF) prevalence increases with age, and sarcopenia is a poor prognostic factor in patients with HF. We aimed to evaluate the characteristics and prognostic factors in patients with HF and sarcopenia. RESULTS We retrospectively reviewed 256 consecutive patients admitted to our hospital for HF between May 2018 and May 2021, underwent dual-energy X-ray absorptiometry, and were diagnosed with sarcopenia. The primary endpoint was all-cause mortality. The prognoses and characteristics were evaluated and compared between patients with left ventricular ejection fraction (LVEF) < 50% (reduced LVEF, HF with reduced ejection fraction [HFrEF]) and those with LVEF ≥ 50% (preserved LVEF, HF with preserved ejection fraction [HFpEF]). 83 (32%) and 173 (68%) patients had HFrEF and HFpEF, respectively. The HFrEF group had fewer women, lower hypertension rates, higher ischemic heart disease rates, and brain natriuretic peptide (BNP) levels than did the HFpEF group. Kaplan-Meier analysis for all-cause death showed that the HFrEF group had a significantly worse prognosis than the HFpEF group [log-rank p = 0.002]. CONCLUSIONS In patients with HF and sarcopenia, older age, higher New York Heart Association (NYHA) class, BNP levels, and reduced LVEF were independent predictors of death after evaluation. During the treatment of patients with HF and sarcopenia, it is necessary to manage treatment with close attention to BNP and LVEF.
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Affiliation(s)
- Yasutaka Imamura
- Department of Cardiology, Rissho Koseikai Kosei Hospital, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kazuho Kamishima
- Department of Cardiology, Rissho Koseikai Kosei Hospital, Tokyo, Japan
| | - Kazuhito Suzuki
- Department of Cardiology, Rissho Koseikai Kosei Hospital, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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2
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Mapelli M, Salvioni E, Bonomi A, Paneroni M, Raimondo R, Gugliandolo P, Mattavelli I, Bidoglio J, Mirza KK, La Rovere MT, Gustafsson F, Agostoni P. Taking a walk on the heart failure side: comparison of metabolic variables during walking and maximal exertion. ESC Heart Fail 2024; 11:1269-1274. [PMID: 38287881 DOI: 10.1002/ehf2.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/20/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024] Open
Abstract
AIMS Although cardiopulmonary exercise testing (CPET) is the gold standard to assess exercise capacity, simpler tests (i.e., 6-min walk test, 6MWT) are also commonly used. The aim of this study was to evaluate the relationship between cardiorespiratory parameters during CPET and 6MWT in a large, multicentre, heterogeneous population. METHODS We included athletes, healthy subjects, and heart failure (HF) patients of different severity, including left ventricular assist device (LVAD) carriers, who underwent both CPET and 6MWT with oxygen consumption measurement. RESULTS We enrolled 186 subjects (16 athletes, 40 healthy, 115 non-LVAD HF patients, and 15 LVAD carriers). CPET-peakV̇O2 was 41.0 [35.0-45.8], 26.2 [23.1-31.0], 12.8 [11.1-15.3], and 15.2 [13.6-15.6] ml/Kg/min in athletes, healthy, HF patients, and LVAD carriers, respectively (P < 0.001). During 6MWT they used 63.5 [56.3-76.8], 72.0 [57.8-81.0], 95.5 [80.3-109], and 95.0 [92.0-99.0] % of their peakV̇O2, respectively. None of the athletes, 1 healthy (2.5%), 30 HF patients (26.1%), and 1 LVAD carrier (6.7%), reached a 6MWT-V̇O2 higher than their CPET-peakV̇O2. Both 6MWT-V̇O2 and walked distance were significantly associated with CPET-peakV̇O2 in the whole population (R2 = 0.637 and R2 = 0.533, P ≤ 0.001) but not in the sub-groups. This was confirmed after adjustment for groups. CONCLUSIONS The 6MWT can be a maximal effort especially in most severe HF patients and suggest that, in absence of prognostic studies related to 6MWT metabolic values, CPET should remain the first method of choice in the functional assessment of patients with HF as well as in sport medicine.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | - Mara Paneroni
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Italy
| | - Rosa Raimondo
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | | | | | | | - Kiran K Mirza
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - Finn Gustafsson
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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3
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Prokopidis K, Morwani-Mangnani J, McDowell G, Lip GYH, Venturelli M, Sankaranarayanan R, Isanejad M. Sarcopenia is linked to higher levels of B-type natriuretic peptide and its N-terminal fragment in heart failure: a systematic review and meta-analysis. Eur Geriatr Med 2024:10.1007/s41999-024-00950-x. [PMID: 38457043 DOI: 10.1007/s41999-024-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/21/2024] [Indexed: 03/09/2024]
Abstract
AIMS Sarcopenia is linked to impaired physical function and exercise tolerance. The aim of this systematic review and meta-analysis was to examine the association of sarcopenia and low appendicular skeletal muscle (ASM) with biomarkers of cardiac function, B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP), in patients with heart failure (HF). METHODS AND RESULTS From inception until May 2023, a systematic literature search of observational studies was undertaken utilizing the PubMed, Web of Science, Scopus, and Cochrane Library databases. A meta-analysis employing a random-effects model was used to compute the pooled effects (CRD42023418465). Overall, 16 studies were included in this systematic review and meta-analysis. Our main analysis showed that sarcopenia in HF was linked to significantly higher levels of BNP (MD: 87.76, 95% CI 20.74-154.78, I2 = 61%, P = 0.01) and NT-proBNP (MD: 947.45, 95% CI 98.97-1795.93, I2 = 35%, P = 0.03). Similarly, low ASM was associated with significantly higher levels of BNP (MD: 118.95, 95% CI 46.91-191.00, I2 = 93%, P < 0.01) and NT-proBNP (MD: 672.01, 95% CI 383.72-960.30, I2 = 2%, P < 0.01). The quality of the included cohort studies was considered moderate, using the binary AXIS checklist and the Cochrane Tool to Assess the Risk of Bias in Cohort Studies. CONCLUSIONS In patients with HF, sarcopenia and reduced ASM are associated with considerably higher plasma levels of BNP and NT-proBNP. Future research is required to investigate whether sarcopenia may express dysregulated biomarkers of cardiac function.
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Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | | | - Garry McDowell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Research Lab, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Masoud Isanejad
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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4
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Saied S, Prokopidis K, Adenaya A, Isanejad M, Sankaranarayanan R. Is sarcopenia an associated factor of increased administration of specific medications in patients with heart failure? A systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1293537. [PMID: 38333416 PMCID: PMC10850377 DOI: 10.3389/fcvm.2024.1293537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/05/2024] [Indexed: 02/10/2024] Open
Abstract
Background There is controversy in relation to commonly used drugs in heart failure (HF) and their impact on muscle function. The aim of this study was to evaluate the odds of receiving specific medications often used in clinical practice by patients with HF and sarcopenia vs. without sarcopenia. Methods A systematic literature search of cohort studies via databases (PubMed, Web of Science, Scopus, and Cochrane Library) was conducted from inception until March 2023. To determine if sarcopenia is linked to a higher number of specific HF-related medications, a meta-analysis using a random-effects model was used to calculate the pooled effects. Results Our main analyses showed no significant association of sarcopenia with administration of higher HF-related medication count vs. those without sarcopenia. Those with lower appendicular lean mass (ALM) had significantly lower odds of receiving angiotensin converting enzyme inhibitors (ACE-Is)/angiotensin receptor blockers (ARBs) (OR: 0.68, 95%CI 0.50-0.90, I2 = 12%, P < 0.01) vs. patients with higher ALM for which age could be an important confounder based on meta-regression. No statistically significant differences were found in relation to B-blockers OR: 0.84, 95%CI 0.63-1.12, I2 = 7%, P = 0.24) and loop diuretics (OR: 1.19, 95%CI 0.87-1.63, I2 = 0%, P = 0.27). Regarding handgrip strength, gait speed, and short physical performance battery, our narrative synthesis found mixed results. Conclusion This systematic review and meta-analysis did not find a relationship of specific medication count in sarcopenia vs. without sarcopenia in patients with HF, although increased odds of ACE-I/ARB was shown in those with higher ALM. Systematic Review Registration PROSPERO (CRD42023411137).
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Affiliation(s)
- Schabnam Saied
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Konstantinos Prokopidis
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Adeoye Adenaya
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Masoud Isanejad
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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5
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Zuo X, Li X, Tang K, Zhao R, Wu M, Wang Y, Li T. Sarcopenia and cardiovascular diseases: A systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2023; 14:1183-1198. [PMID: 37002802 PMCID: PMC10235887 DOI: 10.1002/jcsm.13221] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/23/2022] [Accepted: 03/06/2023] [Indexed: 06/03/2023] Open
Abstract
Sarcopenia is an age-related disease and is often accompanied by other diseases. Now, many studies have shown that cardiovascular diseases (CVDs) may raise the incidence rate of sarcopenia. Therefore, the purpose of this study was to conduct a systematic review and meta-analysis to investigate the prevalence of sarcopenia in patients with CVDs compared with the general population, defined as relatively healthy non-hospitalized subjects. The databases of PubMed, Embase, Medline and Web of Science were searched for eligible studies published up to 12 November 2022. Two assessment tools were used to evaluate study quality and the risk of bias. Statistical analysis was conducted using STATA 14.0 and R Version 4.1.2. Thirty-eight out of the 89 629 articles retrieved were included in our review. The prevalence of sarcopenia ranged from 10.1% to 68.9% in patients with CVDs, and the pooled prevalence was 35% (95% confidence interval [95% CI]: 28-42%). The pooled prevalence of sarcopenia was 32% (95% CI: 23-41%) in patients with chronic heart failure (CHF), 61% (95% CI: 49-72%) in patients with acute decompensated heart failure (ADHF), 43% (95% CI: 2-85%) in patients with coronary artery disease, 30% (95% CI: 25-35%) in patients with cardiac arrhythmia (CA), 35% (95% CI: 10-59%) in patients with congenital heart disease and 12% (95% CI: 7-17%) in patients with unclassed CVDs. However, in the general population, the prevalence of sarcopenia varied from 2.9% to 28.6% and the pooled prevalence was 13% (95% CI: 9-17%), suggesting that the prevalence of sarcopenia in patients with CVDs was about twice compared with the general population. The prevalence of sarcopenia was significantly higher only in patients with ADHF, CHF and CA compared with the general population. There is a positive correlation between CVDs and sarcopenia. The prevalence of sarcopenia is higher in patients with CVDs than that in the general population. With global aging, sarcopenia has brought a heavy burden to individuals and society. Therefore, it is important to identify the populations with high-risk or probable sarcopenia in order to do an early intervention, such as exercise, to counteract or slow down the progress of sarcopenia.
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Affiliation(s)
- Xinrong Zuo
- Department of AnesthesiologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouSichuanChina
| | - Xuehong Li
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for GeriatricsWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Kuo Tang
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for GeriatricsWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Rui Zhao
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for GeriatricsWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Minming Wu
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for GeriatricsWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yang Wang
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for GeriatricsWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Tao Li
- Department of AnesthesiologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouSichuanChina
- Department of Anesthesiology, Laboratory of Mitochondria and Metabolism, National Clinical Research Center for GeriatricsWest China Hospital of Sichuan UniversityChengduSichuanChina
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6
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Damluji AA, Alfaraidhy M, AlHajri N, Rohant NN, Kumar M, Al Malouf C, Bahrainy S, Ji Kwak M, Batchelor WB, Forman DE, Rich MW, Kirkpatrick J, Krishnaswami A, Alexander KP, Gerstenblith G, Cawthon P, deFilippi CR, Goyal P. Sarcopenia and Cardiovascular Diseases. Circulation 2023; 147:1534-1553. [PMID: 37186680 PMCID: PMC10180053 DOI: 10.1161/circulationaha.123.064071] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Sarcopenia is the loss of muscle strength, mass, and function, which is often exacerbated by chronic comorbidities including cardiovascular diseases, chronic kidney disease, and cancer. Sarcopenia is associated with faster progression of cardiovascular diseases and higher risk of mortality, falls, and reduced quality of life, particularly among older adults. Although the pathophysiologic mechanisms are complex, the broad underlying cause of sarcopenia includes an imbalance between anabolic and catabolic muscle homeostasis with or without neuronal degeneration. The intrinsic molecular mechanisms of aging, chronic illness, malnutrition, and immobility are associated with the development of sarcopenia. Screening and testing for sarcopenia may be particularly important among those with chronic disease states. Early recognition of sarcopenia is important because it can provide an opportunity for interventions to reverse or delay the progression of muscle disorder, which may ultimately impact cardiovascular outcomes. Relying on body mass index is not useful for screening because many patients will have sarcopenic obesity, a particularly important phenotype among older cardiac patients. In this review, we aimed to: (1) provide a definition of sarcopenia within the context of muscle wasting disorders; (2) summarize the associations between sarcopenia and different cardiovascular diseases; (3) highlight an approach for a diagnostic evaluation; (4) discuss management strategies for sarcopenia; and (5) outline key gaps in knowledge with implications for the future of the field.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Maha Alfaraidhy
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | - Noora AlHajri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates (N.A.)
| | | | | | | | | | | | - Wayne B Batchelor
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Daniel E Forman
- University of Pittsburgh and the Pittsburgh Geriatric Research Education and Clinical Center, PA (D.E.F.)
| | | | | | | | - Karen P Alexander
- Duke Clinical Research Institute, Duke University, Durham, NC (K.P.A.)
| | - Gary Gerstenblith
- Johns Hopkins University School of Medicine, Baltimore, MD (A.A.D., M.A., G.G.)
| | | | - Christopher R deFilippi
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D., W.B.B., C.R.D.)
| | - Parag Goyal
- University of Arizona, Tucson (N.N.R., P.G.)
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7
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Watanabe H, Koike A, Kato H, Kawamatsu N, Ichinohe T, Machino T, Nishi I, Kawamoto H, Sankai Y, Ieda M. Effects of cardiac rehabilitation with motion assistance from a wearable cyborg hybrid assistive limb on patients with chronic heart failure: a randomized controlled trial with a one-year follow-up. J Phys Ther Sci 2023; 35:114-120. [PMID: 36744202 PMCID: PMC9889210 DOI: 10.1589/jpts.35.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/09/2022] [Indexed: 02/04/2023] Open
Abstract
[Purpose] We have recently reported that using a wearable cyborg hybrid assistive limb improved the isometric knee extensor muscle strength of patients with chronic heart failure. Here, we investigated the long-term effects of a lumbar-type hybrid assistive limb for patients with chronic heart failure. [Participants and Methods] A total of 28 hospitalized patients with chronic heart failure (mean age, 73.1 ± 13.8 years) were randomly assigned to two groups: the hybrid assistive limb group or the control group, in which they performed a sit-to-stand exercise with or without the hybrid assistive limb, respectively. The cardiac rehabilitation therapy included this intervention, which was performed as many times as possible for 5-30 minutes per day for 6-10 days. Clinical assessments like lower-limb muscle strength, walking ability, etc., were measured before and after the intervention. Cardiac events were followed up for up to a year after discharge. [Results] No adverse events occurred during the study period in either group. In terms of long-term effects, the incidence of cardiac events was 23% and 45% in the hybrid assistive limb and the control groups, respectively. [Conclusion] Hybrid assistive limb-assisted exercise therapy may be a safe and feasible cardiac rehabilitation tool in patients with chronic heart failure. The lumbar-type wearable cyborg hybrid assistive limb may have a positive effect on heart failure prognosis by adding long-term exercise therapy.
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Affiliation(s)
- Hiroki Watanabe
- Department of Neurosurgery, Faculty of Medicine, University
of Tsukuba, Japan
| | - Akira Koike
- Department of Cardiology, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan,Corresponding author. Akira Koike (E-mail: )
| | - Hidenori Kato
- Department of Rehabilitation, University of Tsukuba
Hospital, Japan
| | - Naoto Kawamatsu
- Department of Cardiology, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takako Ichinohe
- Department of Cardiology, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takeshi Machino
- Department of Cardiology, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Isao Nishi
- Department of Cardiology, Kamisu Clinical Education and
Training Center, University of Tsukuba Hospital, Japan
| | | | | | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University
of Tsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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8
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Chandrashekhar Iyer L, Vaishali K, Babu AS. Prevalence of sarcopenia in heart failure: A systematic review. Indian Heart J 2023; 75:36-42. [PMID: 36567064 PMCID: PMC9986732 DOI: 10.1016/j.ihj.2022.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Heart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces exercise capacity and leading to poorer outcomes. Therefore, we aimed to systematically investigate the overall prevalence of sarcopenia in HF. METHODS An electronic search was carried out in selected databases until 21st January, 2021. Data was pooled from the included articles and represented as pooled prevalence of sarcopenia. Subgroup analysis was undertaken between methods of diagnosis of sarcopenia, gender, ejection fraction, median time point and geographical region. RESULTS Amongst 32,643 citations imported from selected databases, 12 articles were included in final analysis. Analysis for prevalence of sarcopenia was 34%, with prevalence rates ranging from 10.1% to 68%. Subgroup analysis revealed strong associations between Dual-energy X-ray Absorptiometry (DXA) and Asian Working Group for Sarcopenia (AWGS) (chi square = 3.24; p < 0.001), with a good level of agreement (kappa = 0.76 [95% CI: 0.70-0.82]; p < 0.001). Gender wise analysis revealed higher prevalence of sarcopenia among males (66%) than females (34%). CONCLUSION Sarcopenia is highly prevalent among those with HF (irrespective of type of HF) and is more commonly seen in males compared to females.
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Affiliation(s)
- Lakshman Chandrashekhar Iyer
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; MGM College of Physiotherapy, Sector 30, Navi Mumbai, Maharashtra, India
| | - K Vaishali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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9
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Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, Ishihara S, Iso Y, Ohuchi H, Omiya K, Ohya Y, Okita K, Kimura Y, Koike A, Kohzuki M, Koba S, Sata M, Shimada K, Shimokawa T, Shiraishi H, Sumitomo N, Takahashi T, Takura T, Tsutsui H, Nagayama M, Hasegawa E, Fukumoto Y, Furukawa Y, Miura SI, Yasuda S, Yamada S, Yamada Y, Yumino D, Yoshida T, Adachi T, Ikegame T, Izawa KP, Ishida T, Ozasa N, Osada N, Obata H, Kakutani N, Kasahara Y, Kato M, Kamiya K, Kinugawa S, Kono Y, Kobayashi Y, Koyama T, Sase K, Sato S, Shibata T, Suzuki N, Tamaki D, Yamaoka-Tojo M, Nakanishi M, Nakane E, Nishizaki M, Higo T, Fujimi K, Honda T, Matsumoto Y, Matsumoto N, Miyawaki I, Murata M, Yagi S, Yanase M, Yamada M, Yokoyama M, Watanabe N, Ito H, Kimura T, Kyo S, Goto Y, Nohara R, Hirata KI. JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 2022; 87:155-235. [PMID: 36503954 DOI: 10.1253/circj.cj-22-0234] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University of Medicine
| | - Shunichi Ishihara
- Department of Psychology, Bunkyo University Faculty of Human Sciences
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Hospital
| | - Hideo Ohuchi
- Department of Pediatrics, National Cerebral and Cardiovascular Center
| | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus
| | - Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University
| | - Yutaka Kimura
- Department of Health Sciences, Kansai Medical University Hospital
| | - Akira Koike
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Emiko Hasegawa
- Faculty of Psychology and Social Welfare, Seigakuin University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital
| | | | | | - Takuji Adachi
- Department of Physical Therapy, Nagoya University Graduate School of Medicine
| | | | | | | | - Neiko Ozasa
- Cardiovascular Medicine, Kyoto University Hospital
| | - Naohiko Osada
- Department of Physical Checking, St. Marianna University Toyoko Hospital
| | - Hiroaki Obata
- Division of Internal Medicine, Niigata Minami Hospital.,Division of Rehabilitation, Niigata Minami Hospital
| | | | - Yusuke Kasahara
- Department of Rehabilitation, St. Marianna University Yokohama Seibu Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Yasuyuki Kobayashi
- Department of Medical Technology, Gunma Prefectural Cardiovascular Center
| | | | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University
| | - Shinji Sato
- Department of Physical Therapy, Teikyo Heisei University
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Tamaki
- Department of Nutrition, Showa University Fujigaoka Hospital
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization Okayama Medical Center
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tasuku Honda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare
| | | | - Ikuko Miyawaki
- Department of Nursing, Kobe University Graduate School of Health Sciences
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | | | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Syunei Kyo
- Tokyo Metropolitan Geriatric Medical Center
| | | | | | - Ken-Ichi Hirata
- Department of Internal Medicine, Kobe University Graduate School of Medicine
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10
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Zhou M, Li R, Chen Y, Gao Y, Wei Y, Lu M, Xi J, Lin Z, Zheng X, Jiang H. Impact of resistance exercise rehabilitation and whey protein supplementation in elderly patients with heart failure with preserved ejection fraction with sarcopenia: a study protocol for a randomised controlled trial. BMJ Open 2022; 12:e066331. [PMID: 36600348 PMCID: PMC9730387 DOI: 10.1136/bmjopen-2022-066331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Heart failure with preserved ejection fraction (HFpEF) affects more than half of the patients with heart failure. HFpEF and sarcopenia can interact with each other and contribute to reduced physiological function and increased mortality in elderly patients. Resistance training (RT) or resistance exercise rehabilitation (RER) may have benefits for elderly HFpEF patients with sarcopenia. Whey protein supplementation (WPS) may increase the effects of exercise on strength and muscle mass, in addition to promoting heart function and quality of life (QoL). However, studies are needed to evaluate effects of RER and WPS in patients with HFpEF with sarcopenia. METHODS AND ANALYSIS This is a prospective, randomised, controlled clinical trial in which patients with HFpEF with sarcopenia will be randomly allocated to three groups, control, RT and RT+WP. Participants in all groups will receive basic intervention including standard medicine treatment, home-based aerobic exercise and basic nutritional intervention. The RT group will undergo resistance exercise programmes, and the RT+WP group will receive daily WPS apart from resistance exercise. The study variables will be evaluated at baseline and 12 weeks. Primary outcome measure is the change of 6 min walking distance. Secondary outcomes include parameters of muscle status, cardiac function, nutritional status, QoL and major adverse cardiovascular events. The primary efficacy analysis will follow the intention-to-treat principle. ETHICS AND DISSEMINATION This study was approved by Ethics Committee of China-Japan Friendship Hospital for Clinical Research (No. 2022-KY-003). The results of this study will be disseminated via peer-reviewed publications and presentations at conferences. TRIAL REGISTRATION NUMBER ChiCTR2200061069.
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Affiliation(s)
- Mo Zhou
- Department of Health Care, China-Japan Friendship Hospital, Beijing, Beijing, China
| | - Rui Li
- Department of Health Care, China-Japan Friendship Hospital, Beijing, Beijing, China
| | - Yi Chen
- Department of Health Care, China-Japan Friendship Hospital, Beijing, Beijing, China
| | - Yan Gao
- Department of Health Care, China-Japan Friendship Hospital, Beijing, Beijing, China
| | - Yuhao Wei
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, Beijing, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, Beijing, China
| | - Meishan Lu
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, Beijing, China
- Beijing University of Chinese Medicine, Beijing, Beijing, China
| | - Jieren Xi
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, Beijing, China
- Beijing University of Chinese Medicine, Beijing, Beijing, China
| | - Zhizhou Lin
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, Beijing, China
- Beijing University of Chinese Medicine, Beijing, Beijing, China
| | - Xiaoyun Zheng
- Department of Health Care, China-Japan Friendship Hospital, Beijing, Beijing, China
| | - Hong Jiang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, Beijing, China
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11
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Aida K, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Uchida S, Maekawa E, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. Optimal cutoff values for physical function tests in elderly patients with heart failure. Sci Rep 2022; 12:6920. [PMID: 35484373 PMCID: PMC9051131 DOI: 10.1038/s41598-022-10622-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
Six-minute walk distance (6MWD) of 300 and 400 m are important targets of functional capacity. The present study was performed to determine cutoff values of physical function associated with 6MWD < 300 m and < 400 m in elderly patients with heart failure (HF). 6MWD, handgrip strength, quadriceps isometric strength (QIS), one-leg standing time (OLST), and 5-times sit-to-stand (5STS) before hospital discharge were evaluated in 1001 patients > 65 years (median age, 75: interquartile range, 71-80, 607 men) with HF. 6MWD < 300 and < 400 m were seen in 323 patients (32.3%) and 658 patients (65.7%), respectively. Handgrip strength, QIS, OLST, and 5STS were associated with 6MWD < 300 and < 400 m, respectively (P < 0.001). The cutoff values of handgrip strength, QIS, OLST, and 5STS were 18.9 kg, 35.0% body mass (BM), 9.1 s, and 9.5 s for 6MWD < 300 m, and 21.9 kg, 40.0% BM, 12.0 s, and 8.8 s for < 400 m, respectively. The cutoff values of physical function could be used to set cardiac rehabilitation goals and limiting determinants of reduced functional capacity in a clinical setting in elderly patients with HF.
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Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Physical Medicine and Rehabilitation, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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12
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Impact of physical performance on exercise capacity in older patients with heart failure with reduced and preserved ejection fraction. Exp Gerontol 2021; 156:111626. [PMID: 34780931 DOI: 10.1016/j.exger.2021.111626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Low physical performance may contribute to reduced exercise capacity in older patients with heart failure (HF). We sought to identify the determinants of exercise capacity out of a plethora of background factors, including measures of physical performance. METHODS We performed a post-hoc analysis of a cohort study that included 1205 consecutive older (age ≥ 65 years) hospitalized patients (the median age, 80 years; 57.4% males). RESULTS Low physical performance, defined as ≤1.0 m/s for gait speed, ≥12 s for the 5-time chair stand test, or ≤ 9 points for the Short Physical Performance Battery in both sexes, was seen in 83.9% of the cohort. Multivariate regression analysis revealed that each parameter of physical performance (i.e., gait speed, chair stand test, and balance test) was identified as an independent determinant of lower exercise capacity assessed using the 6-min walking distance. In a logistic regression model, low physical performance predicted short (<300 m) 6-min walking distance (adjusted odds ratio 10.28, 95% CI 6.01-17.60, p < 0.001). No interaction was detected between patients with preserved and reduced ejection fraction. CONCLUSIONS Low physical performance was prevalent and independently associated with exercise capacity in older patients with HF, irrespective of preserved or reduced ejection fraction.
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13
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Zhang Y, Zhang J, Ni W, Yuan X, Zhang H, Li P, Xu J, Zhao Z. Sarcopenia in heart failure: a systematic review and meta-analysis. ESC Heart Fail 2021; 8:1007-1017. [PMID: 33576177 PMCID: PMC8006658 DOI: 10.1002/ehf2.13255] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/04/2021] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
AIMS Sarcopenia has been found to be frequently associated with co-morbidity among patients with heart failure (HF). However, there remain insufficient data to accurately estimate the global prevalence of sarcopenia in HF. Therefore, the purpose of this research was to conduct a systematic review and meta-analysis to estimate the current overall prevalence of sarcopenia in patients with HF. METHODS AND RESULTS We searched relevant databases for studies published up to 13 July 2020, assessing sarcopenia in vpatients with HF. After careful screening, data of included articles were extracted with a predesigned Excel form. Then the pooled prevalence of sarcopenia in patients with HF was calculated using the random-effects model. The Q test was used to assess the heterogeneity, and I2 statistic was calculated to quantify and evaluate the heterogeneity. Subgroup analyses were conducted to determine potential sources of heterogeneity. A total of 2852 articles were initially identified, and after removing duplicate publications and applying the selection criteria, we reviewed 79 full-text articles. Finally, 11 articles (n = 1742 patients with HF) were included in this systematic review and meta-analysis. The pooled prevalence of sarcopenia in patients with HF was 34% [95% confidence interval (CI): 22-47%, I2 = 96.59%] and ranged from 10% to 69%. However, substantial heterogeneity between studies (I2 = 96.59%, P < 0.001) was observed. There was no significant heterogeneity between subgroups by sex (P = 0.803) or the method used to define sarcopenia (P = 0.307). While the heterogeneity between subgroups by population setting was statistically significant (P < 0.001), the pooled prevalence of sarcopenia was 55% (95% CI: 43-66%) for hospitalized patients with HF and 26% (95% CI: 16-37%) for ambulatory patients. CONCLUSIONS Sarcopenia was a common condition in patients with HF, and the prevalence of hospitalized patients was higher than for ambulatory patients. Early detection of sarcopenia was therefore important in patients with HF, and it was important to implement interventions so that physical therapists or managerial dieticians can easily be introduced into clinical practice.
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Affiliation(s)
- Yan Zhang
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Jia Zhang
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Wenqing Ni
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Xueli Yuan
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Hongmin Zhang
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Ping Li
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Jian Xu
- Department of Elderly Health ManagementShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
| | - Zhiguang Zhao
- Administration OfficeShenzhen Center for Chronic Disease ControlShenzhenGuangdong518020China
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14
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Sasaki KI, Kakuma T, Sasaki M, Ishizaki Y, Fukami A, Enomoto M, Adachi H, Matsuse H, Shiba N, Ueno T, Fukumoto Y. The prevalence of sarcopenia and subtypes in cardiovascular diseases, and a new diagnostic approach. J Cardiol 2020; 76:266-272. [DOI: 10.1016/j.jjcc.2020.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/16/2020] [Accepted: 03/05/2020] [Indexed: 01/12/2023]
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15
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Sato M, Inai K, Asagai S, Harada G, Shimada E, Sugiyama H. Skeletal muscle index determined by bioelectrical impedance analysis is a determinant of exercise capacity and a prognostic predictor in patients with congenital heart disease. J Cardiol 2020; 76:413-419. [PMID: 32439338 DOI: 10.1016/j.jjcc.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with congenital heart disease (CHD) reportedly have reduced exercise capacity. Underlying cardiac anatomy and a sedentary lifestyle are thought to be associated with exercise impairment. However, little has been reported regarding the relationship between quantitative body composition and exercise capacity. Bioelectrical impedance analysis (BIA) is a rapid and safe assessment method that has been widely used in clinical research. We hypothesized that bioelectrical impedance parameters are determinants of exercise capacity, and the skeletal muscle index (SMI) determined by BIA is a prognostic predictor in patients with CHD. METHODS We conducted a retrospective single-center study of 305 consecutive patients with CHD [median age, 26 years (range 12-60]; 48% males] admitted between 2014 and 2017. The BIA parameters were reviewed, including the edema index (EI, extracellular water to total body water ratio), SMI (skeletal muscle mass/height2), mineral index (MI, mineral mass/height2), percent body fat (%BF), and exercise capacity [peak oxygen uptake (peakVO2)] via a cardiopulmonary exercise test. RESULTS The multivariate analysis revealed a significant correlation between peakVO2 and EI (r=0.55) and peakVO2 and SMI (r=0.49). The receiver operating characteristic curve analysis showed that the EI cut-off for peakVO2<20ml/kg/min was 0.386 [area under the curve (AUC), 0.77; sensitivity, 0.67; specificity 0.76], and the SMI cut-off was 7.6kg/m2 (AUC, 0.78; sensitivity, 0.76; specificity 0.75). Compared with patients who had biventricular morphology, patients with single ventricular morphology had a higher EI (mean, 0.381 vs. 0.387, respectively) and lower SMI (8.5 vs. 7.7, respectively), resulting in a lower peakVO2 (27.1 vs. 20.8, respectively). The Kaplan-Meier analysis showed that a low SMI was associated with an increased risk of future heart failure-related admissions. CONCLUSIONS SMI determined by BIA is a determinant of exercise capacity and can be used as a prognostic predictor in patients with CHD.
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Affiliation(s)
- Masaki Sato
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Seiji Asagai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Gen Harada
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eriko Shimada
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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