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Shafieesabet A, Scherbakov N, Ebner N, Sandek A, Lokau S, von Haehling S, Anker SD, Lainscak M, Laufs U, Doehner W. Acute effects of oral triglyceride load on dynamic changes in peripheral endothelial function in heart failure patients with reduced ejection fraction and healthy controls. Nutr Metab Cardiovasc Dis 2020; 30:1961-1966. [PMID: 32682746 DOI: 10.1016/j.numecd.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
BACHGROUND Postprandial hyperlipaemia impairs endothelial function, possibly via oxidative-stress-mediated mechanisms. The aim of this study was to evaluate the acute effects of an oral triglyceride load (OTGL) on peripheral endothelial function in heart failure patients with reduced ejection fraction (HFrEF) compared to healthy controls. DESIGN Prospective cross-sectional. METHODS We enrolled 47 patients with HFrEF and 20 healthy controls. Peripheral endothelial function was assessed with EndoPAT2000 technology using a reactive hyperaemia index (RHI) and pulse wave amplitude (PWA) at baseline (after 8-h overnight fasting) as well as 1, 2, 3 and 4-h post-OTGL consumption (250-ml cream drink). Pulse wave amplitude index (PWAI) was calculated as a ratio of PWA at each time point to the baseline PWA. RESULTS RHI at baseline was lower in HFrEF patients compared to controls (1.7 ± 0.3 and 2.3 ± 0.6, respectively; P = 0.001). The OTGL accounted for a physiologic increase in PWA in healthy controls (p = 0.01), but this change was not observed in HFrEF patients. After 4 h, vasodilator response was significantly increased in healthy controls but not patients with HFrEF (2.3 ± 1.3 vs. 1.3 ± 0.8 respectively, P < 0.05). CONCLUSIONS The main finding of this study was the impaired postprandial dynamic changes in peripheral endothelial function in patients with HFrEF compared to healthy controls. A high-fat load that caused acute hypertriglyceridaemia significantly increased resting blood flow and peak flow at reactive hyperaemia in healthy subjects. By contrast, patients with HFrEF exhibited impaired dynamic changes in peripheral endothelial function after oral triglyceride load.
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Affiliation(s)
- Azadeh Shafieesabet
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany; Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin (CSB), Germany.
| | - Nadja Scherbakov
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany; Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin (CSB), Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Germany
| | - Stefanie Lokau
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany; Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Germany
| | - Stefan D Anker
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany; Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Germany
| | - Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany; Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin (CSB), Germany.
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2
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Bielecka-Dabrowa A, Ebner N, Dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 2020; 22:2314-2326. [PMID: 32949422 DOI: 10.1002/ejhf.2011] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022] Open
Abstract
The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Junishi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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3
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von Haehling S, Garfias Macedo T, Valentova M, Anker MS, Ebner N, Bekfani T, Haarmann H, Schefold JC, Lainscak M, Cleland JGF, Doehner W, Hasenfuss G, Anker SD. Muscle wasting as an independent predictor of survival in patients with chronic heart failure. J Cachexia Sarcopenia Muscle 2020; 11:1242-1249. [PMID: 32767518 PMCID: PMC7567155 DOI: 10.1002/jcsm.12603] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Skeletal muscle wasting is an extremely common feature in patients with heart failure, affecting approximately 20% of ambulatory patients with even higher values during acute decompensation. Its occurrence is associated with reduced exercise capacity, muscle strength, and quality of life. We sought to investigate if the presence of muscle wasting carries prognostic information. METHODS Two hundred sixty-eight ambulatory patients with heart failure (age 67.1 ± 10.9 years, New York Heart Association class 2.3 ± 0.6, left ventricular ejection fraction 39 ± 13.3%, and 21% female) were prospectively enrolled as part of the Studies Investigating Co-morbidities Aggravating Heart Failure. Muscle wasting as assessed using dual-energy X-ray absorptiometry was present in 47 patients (17.5%). RESULTS During a mean follow-up of 67.2 ± 28.02 months, 95 patients (35.4%) died from any cause. After adjusting for age, New York Heart Association class, left ventricular ejection fraction, creatinine, N-terminal pro-B-type natriuretic peptide, and iron deficiency, muscle wasting remained an independent predictor of death (hazard ratio 1.80, 95% confidence interval 1.01-3.19, P = 0.04). This effect was more pronounced in patients with heart failure with reduced than in heart failure with preserved ejection fraction. CONCLUSIONS Muscle wasting is an independent predictor of death in ambulatory patients with heart failure. Clinical trials are needed to identify treatment approaches to this co-morbidity.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tarek Bekfani
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Wolfram Doehner
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,BCRT-Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany
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Fonseca GWPD, Garfias Macedo T, Ebner N, Dos Santos MR, de Souza FR, Mady C, Takayama L, Pereira RMR, Doehner W, Anker SD, Negrão CE, Alves MJDNN, von Haehling S. Muscle mass, muscle strength, and functional capacity in patients with heart failure of Chagas disease and other aetiologies. ESC Heart Fail 2020; 7:3086-3094. [PMID: 32860353 PMCID: PMC7524247 DOI: 10.1002/ehf2.12936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/25/2022] Open
Abstract
Aims Patients with Chagas disease and heart failure (HF) have a poor prognosis similar to that of patients with ischaemic or dilated cardiomyopathy. However, the impact of body composition and muscle strength changes in these aetiologies is still unknown. We aimed to evaluate these parameters across aetiologies in two distinct cohort studies [TESTOsterone‐Heart Failure trial (TESTO‐HF; Brazil) and Studies Investigating Co‐morbidities Aggravating Heart Failure (SICA‐HF; Germany)]. Methods and results A total of 64 male patients with left ventricular ejection fraction ≤40% were matched for body mass index and New York Heart Association class, including 22 patients with Chagas disease (TESTO‐HF; Brazil), and 20 patients with dilated cardiomyopathy and 22 patients with ischaemic heart disease (SICA‐HF; Germany). Lean body mass (LBM), appendicular lean mass (ALM), and fat mass were assessed by dual energy X‐ray absorptiometry. Sarcopenia was defined as ALM divided by height in metres squared <7.0 kg/m2 (ALM/height2) and handgrip strength cut‐off for men according to the European Working Group on Sarcopenia in Older People. All patients performed maximal cardiopulmonary exercise testing. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Chagasic and ischaemic patients had lower total fat mass (16.3 ± 8.1 vs. 19.3 ± 8.0 vs. 27.6 ± 9.4 kg; P < 0.05) and reduced peak oxygen consumption (VO2) (1.17 ± 0.36 vs. 1.15 ± 0.36 vs. 1.50 ± 0.45 L/min; P < 0.05) than patients with dilated cardiomyopathy, respectively. Chagasic patients showed a trend towards decreased LBM when compared with ischaemic patients (48.3 ± 7.6 vs. 54.2 ± 6.3 kg; P = 0.09). Chagasic patients showed lower handgrip strength (27 ± 8 vs. 37 ± 11 vs. 36 ± 14 kg; P < 0.05) and FBF (1.84 ± 0.54 vs. 2.75 ± 0.76 vs. 3.42 ± 1.21 mL/min/100 mL; P < 0.01) than ischaemic and dilated cardiomyopathy patients, respectively. There was no statistical difference in the distribution of sarcopenia between groups (P = 0.87). In addition, FBF correlated positively with LBM (r = 0.31; P = 0.012), ALM (r = 0.25; P = 0.046), and handgrip strength (r = 0.36; P = 0.004). In a logistic regression model using peak VO2 as the dependent variable, haemoglobin (odds ratio, 1.506; 95% confidence interval, 1.043–2.177; P = 0.029) and ALM (odds ratio, 1.179; 95% confidence interval, 1.011–1.374; P = 0.035) were independent predictors for peak VO2 adjusted by age, left ventricular ejection fraction, New York Heart Association, creatinine, and FBF. Conclusions Patients with Chagas disease and HF have decreased fat mass and exhibit reduced peripheral blood flow and impaired muscle strength compared with ischaemic HF patients. In addition, patients with Chagas disease and HF show a tendency to have greater reduction in total LBM, with ALM remaining an independent predictor of reduced functional capacity in these patients. The percentage of patients affected by sarcopenia was equal between groups.
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Affiliation(s)
- Guilherme Wesley Peixoto da Fonseca
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
| | | | | | - Charles Mady
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wolfram Doehner
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carlos Eduardo Negrão
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,School of Physical Education and Sports, University of São Paulo, São Paulo, Brazil
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Robert-Koch-Strasse 40, Göttingen, D - 37075, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Göttingen, Germany
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5
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Scherbakov N, Barkhudaryan A, Ebner N, von Haehling S, Anker SD, Joebges M, Doehner W. Early rehabilitation after stroke: relationship between the heart rate variability and functional outcome. ESC Heart Fail 2020; 7:2983-2991. [PMID: 33121218 PMCID: PMC7524118 DOI: 10.1002/ehf2.12917] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Aims Impaired autonomic nervous system regulation is frequently observed in patients with stroke. The aim of this prospective study was to evaluate the impact of cardiac autonomic tone on functional outcome after the early post‐stroke rehabilitation. Methods and results One hundred and three consecutive patients (67 ± 11 years, body mass index (BMI) 27.1 ± 5.4 kg/m2, 64% men) with ischaemic (84% of patients) and haemorrhagic stroke were studied. Depressed heart rate variability (HRV), as a surrogate marker of increased sympathetic tone, was defined by the standard deviation of NN intervals < 100 ms and HRV triangular index ≤ 20 assessed from a 24 h Holter electrocardiogram at admission to rehabilitation (23 ± 16 days after stroke). Twenty‐two per cent of patients had depressed HRV at baseline and were comparable with patients with normal HRV with regard to their functional [Barthel Index (BI), modified Rankin Scale (mRS), and Rivermead Motor Assessment (RMA)] and biochemical status. After a 4‐week follow‐up, 70% of patients with depressed HRV showed a cumulative functional disability, defined by mRS ≥ 4, BI ≤ 70, and RMA ≤ 5, in contrast to patients with normal HRV (35%, P = 0.003). Patients with depressed HRV showed a worse functional status by BI (−16%, P < 0.001), RMA (−12%, P < 0.05), and mRS (+16%, P < 0.01), compared with patients with normal HRV. Cumulative functional disability was associated with depressed HRV (odds ratio 4.25, 95% confidence interval 1.56–11.54, P < 0.005) after adjustment for age, sex, and body mass index (odds ratio 4.6, 95% confidence interval 1.42–14.97, P < 0.05). Conclusions The presence of autonomic cardiovascular dysregulation in patients with subacute stroke was associated with adverse functional outcome after the early post‐stroke rehabilitation.
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Affiliation(s)
- Nadja Scherbakov
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anush Barkhudaryan
- Department of Cardiology, Clinic of General and Invasive Cardiology, University Hospital No. 1, Yerevan State Medical University, Yerevan, Armenia
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology (CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Joebges
- Clinic for Neurology and Neurological Rehabilitation, Schmieder Clinic (Stiftung Co.) KG, Konstanz, Germany
| | - Wolfram Doehner
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
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6
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Bekfani T, Schöbel C, Pietrock C, Valentova M, Ebner N, Döhner W, Schulze PC, Anker SD, von Haehling S. Heart failure and sleep-disordered breathing: susceptibility to reduced muscle strength and preclinical congestion (SICA-HF cohort). ESC Heart Fail 2020; 7:2063-2070. [PMID: 32578399 PMCID: PMC7524208 DOI: 10.1002/ehf2.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Increased sympathetic activation in patients with heart failure (HF) and sleep‐disordered breathing (SDB) provokes cardiac decompensation and protein degradation and could lead to muscle wasting and muscle weakness. The aim of this study was to investigate the differences in body composition, muscle function, and the susceptibility of preclinical congestion among patients with HF and SDB compared with those without SDB. Methods and results We studied 111 outpatients with stable HF who were enrolled into the Studies Investigating Co‐morbidities Aggravating Heart Failure. Echocardiography, short physical performance battery (SPPB), cardiopulmonary exercise testing, dual‐energy X‐ray absorptiometry, bioelectrical impedance analysis (BIA), tests of muscle strength, and polygraphy were performed. SDB was defined as apnoea/hypopnoea index (AHI) >5 per hour of sleep. Central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) were defined as AHI >50% of central or obstructive origin, respectively. A total of 74 patients (66.7%) had any form of SDB [CSA (24 patients, 32.4%), OSA (47 patients, 63.5%)]. Patients with SDB showed increased muscle weakness (chair stand), reduced muscle strength, and lower values of SPPB score (P < 0.05). Patients with SDB did not show overt clinical signs of cardiac decompensation compared with those without SDB (P > 0.05) but had increased amounts of water (total body water, intracellular, and extracellular) measured using BIA (P < 0.05). Increased amounts of total body water were associated with the severity of SDB and inversely with muscle strength and exercise capacity measured by anaerobic threshold (P < 0.05). Altogether, 17 patients had muscle wasting. Of these, 11 (65%) patients had SDB (statistically not significant). Conclusions SDB is highly prevalent in patients with HF. Patients with SDB have lower muscle strength and tend to be more susceptible to preclinical congestion.
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke University, Leipziger Str. 44, Magdeburg, D-39120, Germany
| | - Christoph Schöbel
- Department of Sleep Medicine, Universität Duisburg-Essen, Essen, Germany
| | - Charlotte Pietrock
- Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, University of Göttingen Medical Centre, Göttingen, Germany.,Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic
| | - Nicole Ebner
- Department of Cardiology and Pneumology, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, University of Göttingen Medical Centre, Göttingen, Germany
| | - Wolfram Döhner
- Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.,Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Medical School, Berlin, Germany.,Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Charité Medical School, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, University of Göttingen Medical Centre, Göttingen, Germany
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7
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Fonseca GWPD, Dworatzek E, Ebner N, Von Haehling S. Selective androgen receptor modulators (SARMs) as pharmacological treatment for muscle wasting in ongoing clinical trials. Expert Opin Investig Drugs 2020; 29:881-891. [PMID: 32476495 DOI: 10.1080/13543784.2020.1777275] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Skeletal muscle wasting is a frequent clinical problem encountered in patients with chronic diseases. Increased levels of inflammatory markers play a role in the imbalance between muscle protein synthesis and degradation. Although testosterone has long been proposed as a treatment for patients with muscle wasting, undesirable side effects have raised concerns about prostatic hypertrophy in men as well as virilization in women. Selective androgen receptor modulators (SARMs) have demonstrated similar results like testosterone at improving lean body mass (LBM) with less side effects on androgen-dependent tissue. AREAS COVERED This review outlines the ongoing clinical development in the field of SARMs and their effectiveness in improving body composition and physical function. The included articles were collected at pubmed.gov and analyzed integrally. EXPERT OPINION There is an unmet clinical need for safe and effective anabolic compounds such as SARMs. Despite the effect on LBM shown by SARMs in phase II clinical trials, results on improved physical function and muscle strength are still lacking and long-term outcomes have to be assessed in these patients. Moreover, there is a need to determine the effect of resistance exercise training and protein intake associated with SARMs in the treatment of patients with muscle wasting.
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Affiliation(s)
- Guilherme Wesley Peixoto Da Fonseca
- Heart Institute (Incor), University of São Paulo Medical School , São Paulo, Brazil.,Department of Cardiology and Pneumology, University of Göttingen Medical Center , Göttingen, Germany
| | - Elke Dworatzek
- Institute of Gender in Medicine, Charité - Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health , Berlin, Germany.,Departement of Muscle Physiology, Max-Delbrueck-Center for Molecular Medicine (MDC) in the Helmholtz Association , Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin , Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center , Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen , Göttingen, Germany
| | - Stephan Von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center , Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen , Göttingen, Germany
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8
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von Haehling S, Arzt M, Doehner W, Edelmann F, Evertz R, Ebner N, Herrmann-Lingen C, Garfias Macedo T, Koziolek M, Noutsias M, Schulze PC, Wachter R, Hasenfuß G, Laufs U. Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials. Eur J Heart Fail 2020; 23:92-113. [PMID: 32392403 DOI: 10.1002/ejhf.1838] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/14/2020] [Indexed: 12/28/2022] Open
Abstract
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and - with less certainty - testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Wolfram Doehner
- BCRT - Berlin Institute of Health Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Koziolek
- Department of Nephrology and Rheumatology, University of Göttingen Medical Center, Göttingen, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - P Christian Schulze
- Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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9
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Vatic M, von Haehling S, Ebner N. Inflammatory biomarkers of frailty. Exp Gerontol 2020; 133:110858. [DOI: 10.1016/j.exger.2020.110858] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/15/2022]
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10
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Ebner N, Anker SD, von Haehling S. Recent developments in the field of cachexia, sarcopenia, and muscle wasting: highlights from the 12th Cachexia Conference. J Cachexia Sarcopenia Muscle 2020; 11:274-285. [PMID: 32049447 PMCID: PMC7015230 DOI: 10.1002/jcsm.12552] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/24/2020] [Indexed: 12/15/2022] Open
Abstract
This article highlights preclinical and clinical studies in the field of wasting disorders that were presented at the 12th Cachexia Conference held in Berlin, Germany, in December 2019. Herein, we summarize the biological and clinical significance of different strategies including antibodies that target Fn14, Spsb 1, SAA1 treatment, ZIP14, a MuRF1 inhibitor, and new diagnostic tools like T-cell communication targets and cut-offs for the detection of skeletal muscle wasting. Of particular interest were the transplantation of mesenchymal stromal cells and muscle stem cell communication. Importantly, one presentation discussed the effect of metal ion transporter ZIP14 loss that reduces cancer-induced cachexia. The potential of anti-ZIP14 antibodies and zinc chelation as anti-cachexia therapy may require testing in patients with cancer cachexia. Large clinical studies were presented such as RePOWER (observational study of patients with primary mitochondrial myopathy), MMPOWER (treatment with elamipretide in patients with primary mitochondrial myopathy), and ACT-ONE as well as new mouse models like the KPP mouse. Promising treatments include rapamycin analogue treatment, anamorelin, elanapril, glucocorticoids, SAA1, antibodies that target Fn14, and a MuRF1 inhibitor. Clinical studies investigated novel approaches, including the role of exercise. It remains a fact, however, that effective treatments for cachexia and wasting disorders are urgently needed in order to improve patients' quality of life and their survival.
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)CharitéBerlinGermany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)BerlinGermany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, CharitéBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
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11
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Abstract
Cachexia is a multifactorial disease characterized by a pathologic shift of metabolism towards a more catabolic state. It frequently occurs in patients with chronic diseases such as chronic heart failure and is especially common in the elderly. In patients at risk, cardiac cachexia is found in about 10% of heart failure patients. The negative impact of cardiac cachexia on mortality, morbidity, and quality of life demonstrates the urgent need to find new effective therapies against cardiac cachexia. Furthermore, exercise training and nutritional support can help patients with cardiac cachexia. Despite ongoing efforts to find new therapies for cachexia treatment, also new preventive strategies are needed.
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Affiliation(s)
- Alessia Lena
- Division of Cardiology and Metabolism, Department of Cardiology, Charité-Campus Virchow Klinikum (CVK), Augustenburger Platz 1, 13353 Berlin, Germany.,Department of Cardiology, Charité-Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Föhrer Str. 15, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Strasse 3-4, 10115 Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité-Campus Virchow Klinikum (CVK), Augustenburger Platz 1, 13353 Berlin, Germany.,Department of Cardiology, Charité-Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12203 Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Föhrer Str. 15, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Hessische Strasse 3-4, 10115 Berlin, Germany
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12
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Abstract
There is an increasing awareness of the prevalence of iron deficiency in patients with heart failure (HF), and its contributory role in the morbidity and mortality of HF. Iron is a trace element necessary for cells due to its capacity to transport oxygen and electrons. The prevalence of iron deficiency increases with the severity of HF. For a long time the influence of iron deficiency was underestimated, especially in terms of worsening of cardiovascular diseases and developing anaemia. In recent years, studies with intravenous iron agents in patients with iron deficiency and HF showed new insights into the improvement of iron therapy. Additionally, experimental studies supporting the understanding of iron metabolism and the resulting pathophysiological pathways of iron have been carried out. The aim of this mini review is to highlight why iron deficiency is recognised as an important comorbidity in HF.
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Centre Goettingen Goettingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Centre Goettingen Goettingen, Germany
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13
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Loncar G, Bozic B, Von Haehling S, Cvetinovic N, Lainscak M, Dungen HD, Macedo TG, Ebner N, Vatic M, Otasevic P, Bojic M, Popovic V. P4541Sarcopenia in non-cachectic males with heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sarcopenia has been recently identified as a co-morbidity in patients with heart failure. Whether sarcopenia affects prognosis in non-cachectic HF patients is unknown.
Purpose
To assess the determinants of sarcopenia and its prognostic value in elderly males with HF.
Methods
A total of 73 non-diabetic, non-cachectic, male patients with HF and reduced left ventricular ejection fraction ≤40% (age: 68±7 years, left ventricular ejection fraction 29±8%) were enrolled. Sarcopenia was evaluated in accordance with revised definition of European working group on sarcopenia in older people 2 from 2018. Probable sarcopenia (or presarcopenia) was defined as low muscle strength, evaluated by lowest tertile of grip strength. A sarcopenia diagnosis was confirmed by the presence of low muscle quantity in addition to the low muscle strength, expressed as lowest tertile of appendicular skeletal muscle mass (ASM) adjusted by height square. Muscle mass was measured by dual energy X-ray absorptiometry. Patients were divided into 3 groups according to the diagnosis of the presarcopenia/sarcopenia/nonsarcopenia and were compared in respect to survival.
Results
14 (19%) and 13 (18%) patients were diagnosed with presarcopenia and sarcopenia, respectively. They were older compared to nonsarcopenia patients (72±6 and 73±6 vs. 65±7, p<0.0001), with inferior physical performance expressed by 6-minute walking distance (367±73 and 360±95 vs 430±74 m, p=0.003). Patients with sarcopenia presented with lower body mass index (25±3 vs. 29±6 kg/m2, p=0.014) along with more prominent wasting of bone compartment expressed by reduced total bone mineral content (p=0.002). Creatinine clearance was significantly reduced, while NT-proBNP (log-transformed) was higher in patients with presarcopenia/sarcopenia compared to nonsarcopenia subgroup (p=0.001 and p=0.039, respectively). In multivariate logistic regression only creatinine clearance and 6-minute walking distance were independently related with sarcopenia [OR 0.936 (95% CI 0.891–0.984), p=0.009 and OR 0.992 (95% CI 0.983–1.000), p=0.050, respectively]. A total of 41 (56%) patients died within 6 years of follow-up. Kaplan-Meier survival analysis showed impaired survival in patients with presarcopenia/sarcopenia (p=0.001, Figure 1). In univariate Cox regression analysis determinants of all-cause mortality were: age, NT-proBNP (log-transformed), left ventricular ejection fraction, creatinine clearance and presence of sarcopenia (all p<0.05). In multivariate Cox regression analysis, NT-proBNP [HR 3.000 (95% CI 1.589–5.665), p=0.001], and presence of sarcopenia [HR 0.500 (95% CI 0.241–1.038), p=0.063] were independent determinants of all-cause mortality after 6 years of follow-up.
Survival sarcopenia in heart failure
Conclusions
The rate of presarcopenia and sarcopenia was high in non-cachectic, elderly men with HF, and these patients have impaired survival compared to the patients with normal skeletal muscle status.
Acknowledgement/Funding
Grant of the Ministery of Science of Republic of Serbia 175033
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Affiliation(s)
- G Loncar
- Institute for Cardiovascular Diseases Dedinje, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - B Bozic
- Military Medical Academy of Belgrade, Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia
| | - S Von Haehling
- University of Medicine Göttingen, Charité-University Medical School, Campus Virchow-Klinikum Berlin, DZHK, Gottingen, Berlin, Germany
| | | | - M Lainscak
- General Hospital Murska Sobota and Faculty of Medicine, University of Ljubljana, Murska Sobota, Slovenia
| | - H D Dungen
- Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany, Berlin, Germany
| | - T G Macedo
- University Medical Center Goettingen, Georg-August University, Department of Cardiology and Pneumology, Gottingen, Germany
| | - N Ebner
- University Medical Center Goettingen, Georg-August University, Department of Cardiology and Pneumology, Gottingen, Germany
| | - M Vatic
- Medical University of Goettingen (UMG), Cardiovascular Science program, Gottingen, Germany
| | - P Otasevic
- Institute for Cardiovascular Diseases Dedinje, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Bojic
- Institute for Cardiovascular Diseases Dedinje, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Popovic
- University Belgrade Medical School, Belgrade, Serbia
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14
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Ebner N, Dinopoulos G, Evertz R, Garfias Macedo T, Godoy B, Springer J, Von Haehling S. P6323Exercise capacity as predictor for anaemia or iron deficiency in patients with chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anaemia and iron deficiency (ID) are important factors for muscle function and exercise capacity in patients with chronic heart failure (HF). Their interaction in HF remains to be defined.
Methods
A total of 280 out-patients with stable chronic HF were enrolled with mean age of 67.0±10.7 years, 21%female, mean left ventricular ejection fraction (LVEF) was 38.9±13.4%, mean Body Mass Index (BMI) 29.3±5.5 kg/m2]. Anaemia was defined according to World Health Organization criteria [Haemoglobin (Hb) <13 g/dL in men and <12 g/dL in women]. ID was defined as ferritin <100 μg/L or ferritin <100 <300 μg/L than with transferrin saturation (TSAT) <20%. Exercise capacity was assessed by spiroergometry (peakVO2), 6 minute walk test (6MWT), short physical performance battery test (SPPB), hang grip strength (HGS) and leg force (LF). All patients were followed up for a mean of 8 month.
Results
A total of 89 (32%) chronic HF patients had anaemia and 142 (51%) had iron deficiency at baseline. Patients with anaemia showed significant lower exercise capacity compared to patients without anaemia (peak VO2: 15.3±4.6 vs. 18.5±4.8 kg/min p<0.0001, 6MWT: 365.2±135.5 vs. 461.6±127.4 m p<0.0001, SPPB: 9.4±2.3 vs. 11.0±1.6 total points p<0.0001, HGS: 32.5±10.0 vs. 38.8±12.4 kg p<0.0001, LF: 31.4±11.0 vs. 41.3±21.6 kg p<0.0001). The same we found in patients with ID compared to patients without ID (peak VO2: 16.3±5.1 vs. 18.6±4.5 kg/min p=0.001, 6MWT: 400.0±140.8 vs. 458.8±128.4 m p=0.0008, SPPB: 10.0±2.1 vs. 10.9±1.7 total points p=0.0003, HGS: 34.5±11.9 vs. 39.3±11.7 kg p=0.001, LF: 35.7±23.4 vs. 40.5±13.6 kg p=0.04). After a Follow up of mean 8 month 53 patients develop a new onset of either anaemia (n=24) or ID (n=29). Logistic regression analysis showed that gender, 6 minute walk distance, SPPB, HGS and presence of diabetes mellitus at baseline are significantly associated with the development of anaemia or ID (all p<0.05). The strongest predictor was lower SPPB (p=0.0008). Interestingly known determinates lower peak VO2, higher age, higher NYHA class, Creatinine, and hsCRP were not predictive in our cohort to develop anaemia or ID after 8 month (all p>0.05).
Conclusion
Both anaemia and ID are strongly associated with reduced exercise capacity in patients with HF. The effect of anaemia and iron deficiency together is stronger than that of anemia and ID alone. Reduced SPPB, 6MWT, and HGS are important risk factors for the development of anaemia or ID.
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Affiliation(s)
- N Ebner
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - G Dinopoulos
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - R Evertz
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - T Garfias Macedo
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - B Godoy
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - J Springer
- University Medical Center of Gottingen (UMG), Gottingen, Germany
| | - S Von Haehling
- University Medical Center of Gottingen (UMG), Gottingen, Germany
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15
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Krone O, Kenntner N, Ebner N, Szentiks CA, Dänicke S. Comparing erosion and organ accumulation rates of lead and alternative lead-free ammunition fed to captive domestic ducks. Ambio 2019; 48:1065-1071. [PMID: 30993577 PMCID: PMC6675815 DOI: 10.1007/s13280-019-01183-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/25/2019] [Accepted: 04/03/2019] [Indexed: 05/29/2023]
Abstract
Lead poisoning of birds of prey from ingestion of ammunition lead has been well documented. Alternative, lead-free ammunition is widely available, but the toxicokinetics of other metals in birds are poorly understood. We tested the erosion of lead, copper, zinc, iron and brass by feeding domestic Pekin ducks (Anas platyrhynchos forma domestica) defined numbers of small metal pellets. The accumulation of these metals was analysed in the breast muscle, brain, pancreas, liver and kidney. Four weeks after application, the ducks were euthanized and necropsied, internal organs tested for metal accumulation and gizzard pellets collected and weighed to record loss by erosion. Degree of erosion was highest in zinc pellets (81% mass loss), followed by iron (46%) and lead (45%) and was only marginal in copper and brass. Only lead showed highly elevated levels of accumulation in organs compared to controls.
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Affiliation(s)
- Oliver Krone
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), P.O. 601103, 10252, Berlin, Germany.
| | - Norbert Kenntner
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), P.O. 601103, 10252, Berlin, Germany
| | - Nicole Ebner
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), P.O. 601103, 10252, Berlin, Germany
| | - Claudia A Szentiks
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research (IZW), P.O. 601103, 10252, Berlin, Germany
| | - Sven Dänicke
- Institute of Animal Nutrition (ITE), Bundesallee 37, 38116, Braunschweig, Germany
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16
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical School, German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Nicole Ebner
- Department of Cardiology and PneumologyUniversity of Göttingen Medical School, German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism—Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK), and Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) BerlinCharité Universitätsmedizin BerlinBerlinGermany
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17
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Scherbakov N, Pietrock C, Sandek A, Ebner N, Valentova M, Springer J, Schefold JC, von Haehling S, Anker SD, Norman K, Haeusler KG, Doehner W. Body weight changes and incidence of cachexia after stroke. J Cachexia Sarcopenia Muscle 2019; 10:611-620. [PMID: 30680953 PMCID: PMC6596391 DOI: 10.1002/jcsm.12400] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Body weight loss is a frequent complication after stroke, and its adverse effect on clinical outcome has been shown in several clinical trials. The purpose of this prospective longitudinal single-centre observational study was to investigate dynamical changes of body composition and body weight after ischemic stroke and an association with functional outcome. METHODS Sixty-seven consecutive patients (age 69 ± 11 years, body mass index 27.0 ± 4.1 kg/m2 , 42% female patient, mean ± SD) with acute ischemic stroke with mild to moderate neurological deficit (National Institute of Health Stroke Scale median 4, ranged 0-12) were analysed in the acute phase (4 ± 2 days) and at 12 months (389 ± 26 days) follow-up. Body composition was examined by dual energy X-ray absorptiometry. Cachexia was defined according to the consensus definition by body weight loss ≥5% within 1 year and additional clinical signs. Lean tissue wasting was considered if a ratio of upper and lower limbs lean mass sum to squared height (kg/m2 ) was ≤5.45 kg/m2 for female patient and ≤7.25 kg/m2 for male patient. RESULTS According to the body weight changes after 12 months, 42 (63%) patients had weight gain or stable weight, 11 (16%) patients had moderate weight loss, and 14 (21%) patients became cachectic. A relative decline of 19% of fat tissue and 6.5% of lean tissue was observed in cachectic patients, while no changes of lean tissue were observed in non-cachectic patients after 12 months. The modified Rankin Scale was 48% higher (2.1 ± 1.6, P < 0.05), Barthel Index was 22% lower (71 ± 39, P < 0.01), and handgrip strength was 34% lower (21.9 ± 13.0, P < 0.05) in cachectic compared to non-cachectic patients after 12 months. The low physical performance if defined by Barthel Index <60 points was linked to the lean tissue wasting (OR 44.8, P < 0.01), presence of cachexia (OR 20.8, P < 0.01), and low body mass index <25 kg/m2 (OR 11.5, P < 0.05). After adjustment for cofounders, lean tissue wasting remained independently associated with the low physical performance at 12 months follow-up (OR 137.9, P < 0.05). CONCLUSIONS In this cohort study, every fifth patient with ischemic stroke fulfilled the criteria of cachexia within 12 months after index event. The incidence of cachexia was 21%. Cachectic patients showed the lowest functional and physical capacity.
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Affiliation(s)
- Nadja Scherbakov
- BIH Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany
| | - Charlotte Pietrock
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Goettingen, Goettingen, Germany
| | - Jochen Springer
- BIH Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, Switzerland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany
| | - Stefan D Anker
- BIH Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Kristina Norman
- Research Group on Geriatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam Rehbrücke, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Germany.,Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany
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Ebner N, Anker SD, von Haehling S. Recent developments in the field of cachexia, sarcopenia, and muscle wasting: highlights from the 11th Cachexia Conference. J Cachexia Sarcopenia Muscle 2019; 10:218-225. [PMID: 30920774 PMCID: PMC6438336 DOI: 10.1002/jcsm.12408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/16/2022] Open
Abstract
This article highlights the updates from preclinical and clinical studies into the field of wasting disorders that were presented at the 11th Cachexia Conference held in Maastricht, the Netherlands, in December 2018. Herein, we summarize the biological and clinical significance of different markers and new diagnostic tools and cut-offs for the detection of skeletal muscle wasting, including micro-RNAs, siRNAs, epigenetic targets, the ubiquitin-proteasome system, mammalian target of rapamycin signalling, news in body composition analysis including the D3-creatine dilution method, and electrocardiography that was modified to enable segmental impedance spectroscopy. Of particular interest were the beneficial effects of BIO101 on muscle cell differentiation, hypertrophy of myofibers associated with mammalian target of rapamycin pathways activation, and the effect of metal ion transporter ZIP14 loss that reduces cancer-induced cachexia. The potential of anti-ZIP14 antibodies and zinc chelation as anti-cachexia therapy should be tested in patients with cancer cachexia. Big randomized studies were presented such as RePOWER (observational study of patients with primary mitochondrial myopathy), STRAMBO (influence of physical performance assessed as score and clinical testing), MMPOWER (treatment of elamipretide in subjects with primary mitochondrial myopathy), FORCE (examined differences in relative dose intensity and moderate and severe chemotherapy-associated toxicities between a strength training intervention and a control group), and SPRINTT (effectiveness of exercise training in healthy aging). Effective treatments were urothelin A, rapamycin analogue treatment, epigenetic factor BRD 4 and epigenetic protein BET, and the gut pathobiont Klebsiella oxytoca. Clinical studies that investigated novel approaches, including urolithin A, the role of gut microbiota, metal ion transporter ZIP14, lysophosphatidylcholine and lysophosphatidylethanolamine, and BIO101, were described. It remains a fact, however, that effective treatments of cachexia and wasting disorders are urgently needed in order to improve patients' quality of life and their survival.
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Charité, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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19
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von Haehling S, Ebner N, Evertz R, Ponikowski P, Anker SD. Iron Deficiency in Heart Failure: An Overview. JACC Heart Fail 2018; 7:36-46. [PMID: 30553903 DOI: 10.1016/j.jchf.2018.07.015] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022]
Abstract
Iron deficiency is an extremely common comorbidity in patients with heart failure, affecting up to 50% of all ambulatory patients. It is associated with reduced exercise capacity and physical well-being and reduced quality of life. Cutoff values have been identified for diagnosing iron deficiency in heart failure with reduced ejection fraction as serum ferritin, <100 μg/l, or ferritin, 100 to 300 μg/l, with transferrin saturation of <20%. Oral iron products have been shown to have little efficacy in heart failure, where the preference is intravenous iron products. Most clinical studies have been performed using ferric carboxymaltose with good efficacy in terms of improvements in 6-min walk test distance, peak oxygen consumption, quality of life, and improvements in New York Heart Association functional class. Data from meta-analyses also suggest beneficial effects for hospitalization rates for heart failure and reduction in cardiovascular mortality rates. A prospective trial to investigate effects on morbidity and mortality is currently ongoing. This paper highlights current knowledge of the pathophysiology of iron deficiency in heart failure, its prevalence and clinical impact, and its possible treatment options.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Stefan D Anker
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
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20
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site: Department of Cardiology Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Stefan D Anker
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site: Department of Cardiology Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology (CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
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21
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Emami A, Saitoh M, Valentova M, Sandek A, Evertz R, Ebner N, Loncar G, Springer J, Doehner W, Lainscak M, Hasenfuß G, Anker SD, von Haehling S. Comparison of sarcopenia and cachexia in men with chronic heart failure: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Eur J Heart Fail 2018; 20:1580-1587. [PMID: 30160804 DOI: 10.1002/ejhf.1304] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 12/16/2022] Open
Abstract
AIMS Changes in heart failure (HF) patients' body composition may be associated with reduced exercise capacity. The aim of the present study was to determine the overlap in wasting syndromes in HF (cachexia and sarcopenia) and to compare their functional impact. METHODS AND RESULTS We prospectively enrolled 207 ambulatory male patients with clinically stable chronic HF. All patients underwent a standardized protocol examining functional capacity, body composition, and quality of life (QoL). Cachexia was present in 39 (18.8%) of 207 patients, 14 of whom also fulfilled the characteristics of sarcopenia (sarcopenia + cachexia group, 6.7%), whereas 25 did not (cachectic HF group, 12.1%). Sarcopenia without cachexia was present in 30 patients (sarcopenic HF group, 14.4%). A total of 44 patients (21.3%) presented with sarcopenia; however, 138 patients showed no signs of wasting (no wasting group, 66%). Patients with sarcopenia had lower strength and exercise capacity than both the no wasting and the cachectic HF group. Handgrip strength, quadriceps strength, peak oxygen uptake (VO2 ), distance in the 6-minute walk test (6MWT), and QoL results were lowest in the sarcopenia + cachexia group vs. the no wasting group (P < 0.05 for all). Likewise, the sarcopenic HF group showed lower handgrip strength, quadriceps strength, 6MWT, peak VO2 , and QoL results vs. the no wasting group (P < 0.05 for all). CONCLUSION Losing muscle with or without weight loss appears to have a more pronounced role than weight loss alone with regard to functional capacity and QoL among male patients with chronic HF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01872299.
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Affiliation(s)
- Amir Emami
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Masakazu Saitoh
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Goran Loncar
- Institute for cardiovascular diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jochen Springer
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin, Charite University Medical School, Germany.,Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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22
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Scherbakov N, Pietrock C, Sandek A, Ebner N, Valentova M, Fiebach JB, Schefold JC, Von Haehling S, Anker SD, Norman K, Haeusler KG, Doehner W. 1200Body weight changes and incidence of cachexia after stroke. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Scherbakov
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - C Pietrock
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - A Sandek
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - N Ebner
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - M Valentova
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - J B Fiebach
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - J C Schefold
- Bern University Hospital, Department of Intensive Care Medicine, Inselspital, Bern, Bern, Switzerland
| | - S Von Haehling
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - S D Anker
- German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
| | - K Norman
- Charité - Universitätsmedizin Berlin, Research Group on Geriatrics, Berlin, Germany
| | - K G Haeusler
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - W Doehner
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
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23
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Bekfani T, Pellicori P, Morris D, Ebner N, Valentova M, Sandek A, Doehner W, Cleland JG, Lainscak M, Schulze PC, Anker SD, von Haehling S. Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life. Clin Res Cardiol 2018; 108:203-211. [PMID: 30051186 DOI: 10.1007/s00392-018-1344-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of iron deficiency (ID) in outpatients with heart failure with preserved ejection fraction (HFpEF) and its relation to exercise capacity and quality of life (QoL) is unknown. METHODS 190 symptomatic outpatients with HFpEF (LVEF 58 ± 7%; age 71 ± 9 years; NYHA 2.4 ± 0.5; BMI 31 ± 6 kg/m2) were enrolled as part of SICA-HF in Germany, England and Slovenia. ID was defined as ferritin < 100 or 100-299 µg/L with transferrin saturation (TSAT) < 20%. Anemia was defined as Hb < 13 g/dL in men, < 12 g/dL in women. Low ferritin-ID was defined as ferritin < 100 µg/L. Patients were divided into 3 groups according to E/e' at echocardiography: E/e' ≤ 8; E/e' 9-14; E/e' ≥ 15. All patients underwent echocardiography, cardiopulmonary exercise test (CPX), 6-min walk test (6-MWT), and QoL assessment using the EQ5D questionnaire. RESULTS Overall, 111 patients (58.4%) showed ID with 89 having low ferritin-ID (46.84%). 78 (41.1%) patients had isolated ID without anemia and 54 patients showed anemia (28.4%). ID was more prevalent in patients with more severe diastolic dysfunction: E/e' ≤ 8: 44.8% vs. E/e': 9-14: 53.2% vs. E/e' ≥ 15: 86.5% (p = 0.0004). Patients with ID performed worse during the 6MWT (420 ± 137 vs. 344 ± 124 m; p = 0.008) and had worse exercise time in CPX (645 ± 168 vs. 538 ± 178 s, p = 0.03). Patients with low ferritin-ID had lower QoL compared to those without ID (p = 0.03). CONCLUSION ID is a frequent co-morbidity in HFpEF and is associated with reduced exercise capacity and QoL. Its prevalence increases with increasing severity of diastolic dysfunction.
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Affiliation(s)
- Tarek Bekfani
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany.
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany.
| | | | - Daniel Morris
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Wolfram Doehner
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | | | - Mitja Lainscak
- Department of Cardiology, Golnik University, Golnik, Slovenia
| | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Medical School Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in LodzMedical University of LodzPoland
| | - Stefan D. Anker
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) partner site Berlin; Charité Universitätsmedizin BerlinBerlinGermany
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
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Abstract
This article highlights the updates from preclinical and clinical studies into the field of wasting disorders that were presented at the 10th Cachexia Conference held in Rome, Italy, in December 2017. This year's conference saw some interesting results of larger-scale studies and clinical trials and new therapeutic targets. Herein, we summarize the biological and clinical significance of different markers and new diagnostic tools and cut-offs for the detection of skeletal muscle wasting, including micro RNAs, the ubiquitin-proteasome system, mTOR signalling, news in body composition analysis including the D3-creatine dilution method, and new biomarkers. Clinical studies investigated novel nutritional approaches, trials of elamipretide, enobosarm, and urolithin A. It remains a fact, however, that effective treatments of cachexia and wasting disorders are urgently needed in order to improve patients' quality of life and their survival.
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and Pneumology, Innovative Clinical TrialsUniversity Medical Center GoettingenGoettingenGermany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Innovative Clinical TrialsUniversity Medical Center GoettingenGoettingenGermany
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26
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Abstract
INTRODUCTION Sarcopenia is a common feature, and affects 20-47% of patients with heart failure (HF). Sarcopenia is also an independent predictor of impaired functional capacity, even after adjusting for clinical relevant variables, which is associated with adverse outcome in patients with HF. Areas covered: Several different pathophysiological pathways are involved in sarcopenic processes including altered nutrient intake and absorption, hormonal factor, inflammatory processes, oxidative stress, cellular proteolysis, and unhealthy lifestyle. Nutritional therapy, physical activity and/or exercise training have been associated with improved muscle mass or physical performance in HF. Few studies reported beneficial effects for muscle mass and physical performance, in those who received angiotensin-converting enzyme (ACE) inhibitors, or/and beta-blocker. In addition, testosterone, selective androgen receptor modulators, ghrelin agonist and myostatin inhibitors are currently under study as possible future therapeutic options. Expert commentary: Regular and adequate level of physical activity and/or exercise training, and sufficient nutritional intake or special nutritional supplementation may represent the best strategy for prevention or delay of sarcopenia and worsening physical performance in patients with HF. Maximal tolerated dosages of standard therapies for HF such as ACE-inhibitors or beta-blockers are first-line strategy, however it is difficult to recommend other pharmacological agents as part of routine treatment of sarcopenia.
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Affiliation(s)
- Masakazu Saitoh
- a Department of Cardiology and Pneumology , University Medical Center Göttingen , Göttingen , Germany
| | - Nicole Ebner
- a Department of Cardiology and Pneumology , University Medical Center Göttingen , Göttingen , Germany
| | - Stephan von Haehling
- a Department of Cardiology and Pneumology , University Medical Center Göttingen , Göttingen , Germany
| | - Stefan D Anker
- a Department of Cardiology and Pneumology , University Medical Center Göttingen , Göttingen , Germany.,b Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) , Berlin , Germany.,c Berlin-Brandenburg Center for Regenerative Therapies (BCRT) , Berlin , Germany.,d Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) , Berlin , Germany.,e Charité Universitätsmedizin , Berlin , Germany
| | - Jochen Springer
- a Department of Cardiology and Pneumology , University Medical Center Göttingen , Göttingen , Germany
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27
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Barazzoni R, Gortan Cappellari G, Palus S, Vinci P, Ruozi G, Zanetti M, Semolic A, Ebner N, von Haehling S, Sinagra G, Giacca M, Springer J. Acylated ghrelin treatment normalizes skeletal muscle mitochondrial oxidative capacity and AKT phosphorylation in rat chronic heart failure. J Cachexia Sarcopenia Muscle 2017; 8:991-998. [PMID: 29098797 PMCID: PMC5700435 DOI: 10.1002/jcsm.12254] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is associated with skeletal muscle abnormalities contributing to exercise intolerance, muscle loss, and negative impact on patient prognosis. A primary role has been proposed for mitochondrial dysfunction, which may be induced by systemic and tissue inflammation and further contribute to low insulin signalling. The acylated form of the gastric hormone ghrelin (AG) may improve mitochondrial oxidative capacity and insulin signalling in both healthy and diseased rodent models. METHODS We investigated the impact of AG continuous subcutaneous administration (AG) by osmotic minipump (50 nmol/kg/day for 28 days) compared with placebo (P) on skeletal muscle mitochondrial enzyme activities, mitochondrial biogenesis regulators transcriptional expression and insulin signalling in a rodent post-myocardial infarction CHF model. RESULTS No statistically significant differences (NS) were observed among the three group in cumulative food intake. Compared with sham-operated, P had low mitochondrial enzyme activities, mitochondrial biogenesis regulators transcripts, and insulin signalling activation at AKT level (P < 0.05), associated with activating nuclear translocation of pro-inflammatory transcription factor nuclear factor-κB. AG completely normalized all alterations (P < 0.05 vs P, P = NS vs sham-operated). Direct AG activities were strongly supported by in vitro C2C12 myotubes experiments showing AG-dependent stimulation of mitochondrial enzyme activities. No changes in mitochondrial parameters and insulin signalling were observed in the liver in any group. CONCLUSIONS Sustained peripheral AG treatment with preserved food intake normalizes a CHF-induced tissue-specific cluster of skeletal muscle mitochondrial dysfunction, pro-inflammatory changes, and reduced insulin signalling. AG is therefore a potential treatment for CHF-associated muscle catabolic alterations, with potential positive impact on patient outcome.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences-University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Gianluca Gortan Cappellari
- Internal Medicine, Department of Medical, Surgical and Health Sciences-University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Sandra Palus
- Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Pierandrea Vinci
- Internal Medicine, Department of Medical, Surgical and Health Sciences-University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Giulia Ruozi
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Michela Zanetti
- Internal Medicine, Department of Medical, Surgical and Health Sciences-University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Annamaria Semolic
- Internal Medicine, Department of Medical, Surgical and Health Sciences-University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Nicole Ebner
- Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Gianfranco Sinagra
- Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.,Cardiology Division, Department of Medical, Surgical and Health Sciences-University of Trieste, Trieste, Italy
| | - Mauro Giacca
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Jochen Springer
- Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
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Emami A, Ebner N, von Haehling S. Publishing in a heart failure journal-where lies the scientific interest? ESC Heart Fail 2017; 4:389-401. [PMID: 29131547 PMCID: PMC5695188 DOI: 10.1002/ehf2.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Amir Emami
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany
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29
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Saitoh M, Ishida J, Ebner N, Anker SD, Von Haehling S. Myostatin inhibitors as pharmacological treatment for muscle wasting and muscular dystrophy. JCSM Clinical Reports 2017. [DOI: 10.17987/jcsm-cr.v2i1.37] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myostatin, a member of the transforming growth factor beta (TGF-β) superfamily that is highly expressed in skeletal muscle, was first described in 1997. It has been known that loss of myostatin function induces an increase in muscle mass in mice, cow, dogs and humans. Therefore, myostatin and its receptor have emerged as a therapeutic target for loss of skeletal muscle such as sarcopenia and cachexia, as well as muscular dystrophies. At the molecular level, myostatin binds to and activates the activin receptor IIB (ActRIIB)/Alk 4/5 complex. Therapeutic approaches therefore are being taken both pre-clinically and clinically to inhibit the myostatin signaling pathway. Several myostatin inhibitors , including myostatin antibodies, anti-myostatin peptibody, activin A antibody, soluble (decoy) forms of ActRIIB (ActRⅡB-Fc), anti-myostatin adnectin, ActRⅡB antibody have been tested in the last decade. The current review covers the present knowledge of several myostatin inhibitors as therapeutic approach for patients with loss of skeletal muscle however, the available information about compounds in development is limited.
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von Haehling S, Ebner N, Anker SD. Oodles of opportunities: the Journal of Cachexia, Sarcopenia and Muscle in 2017. J Cachexia Sarcopenia Muscle 2017; 8:675-680. [PMID: 29076661 PMCID: PMC5659063 DOI: 10.1002/jcsm.12247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
| | - Nicole Ebner
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism—Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK); and Berlin‐Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) BerlinCharité Universitätsmedizin BerlinBerlinGermany
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Saitoh M, Dos Santos MR, Emami A, Ishida J, Ebner N, Valentova M, Bekfani T, Sandek A, Lainscak M, Doehner W, Anker SD, von Haehling S. Anorexia, functional capacity, and clinical outcome in patients with chronic heart failure: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). ESC Heart Fail 2017; 4:448-457. [PMID: 28960880 PMCID: PMC5695184 DOI: 10.1002/ehf2.12209] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022] Open
Abstract
Aims We aimed to assess determinants of anorexia, that is loss of appetite in patients with heart failure (HF) and aimed to further elucidate the association between anorexia, functional capacity, and outcomes in affected patients. Methods and results We assessed anorexia status among 166 patients with HF (25 female, 66 ± 12 years) who participated in the Studies Investigating Co‐morbidities Aggravating HF. Anorexia was assessed by a 6‐point Likert scale (ranging from 0 to 5), wherein values ≥1 indicate anorexia. Functional capacity was assessed as peak oxygen uptake (peak VO2), 6 min walk test, and short physical performance battery test. A total of 57 patients (34%) reported any anorexia, and these patients showed lower values of peak VO2, 6 min walk distance, and short physical performance battery score (all P < 0.05). Using multivariate analysis adjusting for clinically important factors, only high‐sensitivity C‐reactive protein [odds ratio (OR) 1.24, P = 0.04], use of loop diuretics (OR 5.76, P = 0.03), and the presence of cachexia (OR 2.53, P = 0.04) remained independent predictors of anorexia. A total of 22 patients (13%) died during a mean follow‐up of 22.5 ± 5.1 months. Kaplan‐Meier curves for cumulative survival showed that those patients with anorexia presented higher mortality (Log‐rank test P = 0.03). Conclusions Inflammation, use of loop diuretics, and cachexia are associated with an increased likelihood of anorexia in patients with HF, and patients with anorexia showed impaired functional capacity and poor outcomes.
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Affiliation(s)
- Masakazu Saitoh
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Marcelo R Dos Santos
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Amir Emami
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Junichi Ishida
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Mitja Lainscak
- Faculty of Medicine, Ljubljana, Slovenia; Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
| | - Wolfram Doehner
- Centre for Stroke Research Berlin and Department of Cardiology, Virchow Klinikum, Charité-Universitätsmedizin, Berlin, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany.,Division of Cardiology and Metabolism - Heart Failure, Cachexia and Sarcopenia; Department of Internal Medicine and Cardiology, Berlin-Brandenburg Center for Regenerative Therapies (BCRT) at Charité University Medicine, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
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Scherbakov N, Sandek A, Ebner N, Valentova M, Nave AH, Jankowska EA, Schefold JC, von Haehling S, Anker SD, Fietze I, Fiebach JB, Haeusler KG, Doehner W. Sleep-Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction. J Am Heart Assoc 2017; 6:JAHA.117.006010. [PMID: 28893762 PMCID: PMC5634268 DOI: 10.1161/jaha.117.006010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) after acute ischemic stroke is frequent and may be linked to stroke-induced autonomic imbalance. In the present study, the interaction between SDB and peripheral endothelial dysfunction (ED) was investigated in patients with acute ischemic stroke and at 1-year follow-up. METHODS AND RESULTS SDB was assessed by transthoracic impedance records in 101 patients with acute ischemic stroke (mean age, 69 years; 61% men; median National Institutes of Health Stroke Scale, 4) while being on the stroke unit. SDB was defined by apnea-hypopnea index ≥5 episodes per hour. Peripheral endothelial function was assessed using peripheral arterial tonometry (EndoPAT-2000). ED was defined by reactive hyperemia index ≤1.8. Forty-one stroke patients underwent 1-year follow-up (390±24 days) after stroke. SDB was observed in 57% patients with acute ischemic stroke. Compared with patients without SDB, ED was more prevalent in patients with SDB (32% versus 64%; P<0.01). After adjustment for multiple confounders, presence of SDB remained independently associated with ED (odds ratio, 3.1; [95% confidence interval, 1.2-7.9]; P<0.05). After 1 year, the prevalence of SDB decreased from 59% to 15% (P<0.001). Interestingly, peripheral endothelial function improved in stroke patients with normalized SDB, compared with patients with persisting SDB (P<0.05). CONCLUSIONS SDB was present in more than half of all patients with acute ischemic stroke and was independently associated with peripheral ED. Normalized ED in patients with normalized breathing pattern 1 year after stroke suggests a mechanistic link between SDB and ED. CLINICAL TRIAL REGISTRATION URL: https://drks-neu.uniklinik-freiburg.de. Unique identifier: DRKS00000514.
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Affiliation(s)
- Nadja Scherbakov
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Sandek
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany
| | - Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany
| | - Miroslava Valentova
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany
| | - Alexander Heinrich Nave
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Cardiology Department, Military Hospital, Wroclaw, Poland
| | - Jörg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, Switzerland
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Georg Haeusler
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Trippel TD, Ebner N, Loncar G, Von Haehling S. On the broad field of clinical cachexia, sarcopenia and muscle research. JCSM Clinical Reports 2017. [DOI: 10.17987/jcsm-cr.v2i2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The past months have brought an interesting array of international submissions ranging from prognostic implications of body mass index and tissue loss in cancer to chronic kidney disease to this journal. Manuscripts on imaging or biomarkers aspects, among others, draw a heterogeneous picture of clinical reports in the field. Yet, upon completion of JCSM Clinical Reports’ Issue 1, Volume 2 we are delighted to display the rapid progress this editorial project takes on the large topic of cachexia, sarcopenia and muscle research. Coherently, we follow our stringent editorial path and hope to consider and integrate a ‘broad field’ from a clinical point of view.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Marcelo R Dos Santos
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Dr. Arnaldo Avenue, 455 Cerqueira César, 01246903 Sao Paulo, Brazil
| | - Jochen Springer
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Brandenburg Center for Regenerative Therapies, Charité Medical School, Augustenburger Platz 1, 13353 Berlin, Germany
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Bekfani T, Schoebel C, Pietrock C, Valentova M, Ebner N, Elsner S, Sandek A, Doehner W, Noutsias M, Schulze P, Anker S, Von Haehling S. P4386Sleep disordered breathing (SDB) increases the risk of heart failure decompensation: clinical factors and bioelectrical impedance analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
This article highlights updates of pathways as well as pre-clinical and clinical studies into the field of wasting disorders that were presented at the 9th Cachexia Conference held in Berlin, Germany, December 2016. This year, some interesting results from clinical trials and different new therapeutic targets were shown. This article presents the biological and clinical significance of different markers and new diagnostic tools and cut-offs of detecting skeletal muscle wasting. Effective treatments of cachexia and wasting disorders are urgently needed in order to improve the patients' quality of life and their survival.
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
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Abstract
Body wasting is a serious complication that affects a large proportion of patients with heart failure. Muscle wasting, also known as sarcopenia, is the loss of muscle mass and strength, whereas cachexia describes loss of weight. After reaching guideline-recommended doses of heart failure therapies, the most promising approach to treating body wasting seems to be combined therapy that includes exercise, nutritional counselling, and drug treatment. Nutritional considerations include avoiding excessive salt and fluid intake, and replenishment of deficiencies in trace elements. Administration of omega-3 polyunsaturated fatty acids is beneficial in selected patients. High-calorific nutritional supplements can also be useful. The prescription of aerobic exercise training that provokes mild or moderate breathlessness has good scientific support. Drugs with potential benefit in the treatment of body wasting that have been tested in clinical studies in patients with heart failure include testosterone, ghrelin, recombinant human growth hormone, essential amino acids, and β2-adrenergic receptor agonists. In this Review, we summarize the pathophysiological mechanisms of muscle wasting and cachexia in heart failure, and highlight the potential treatment strategies. We aim to provide clinicians with the relevant information on body wasting to understand and treat these conditions in patients with heart failure.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Marcelo R Dos Santos
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Dr. Arnaldo Avenue, 455 Cerqueira César, 01246903 Sao Paulo, Brazil
| | - Jochen Springer
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre and DZHK (German Centre for Cardiovascular Research), Robert-Koch-Strasse 40, D-37075 Göttingen, Germany.,Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Berlin-Brandenburg Centre for Regenerative Therapies, Charité Medical School, Augustenburger Platz 1, 13353 Berlin, Germany
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Konishi M, Ebner N, Springer J, Schefold JC, Doehner W, Dschietzig TB, Anker SD, von Haehling S. Impact of Plasma Kynurenine Level on Functional Capacity and Outcome in Heart Failure ― Results From Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) ―. Circ J 2017; 81:52-61. [DOI: 10.1253/circj.cj-16-0791] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaaki Konishi
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School
| | - Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern
| | - Wolfram Doehner
- Campus Virchow, Center for Stroke Research Berlin and Department of Cardiology, Charité Medical School
| | | | - Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School
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Von Haehling S, Ebner N, Morley JE, Coats AJS, Anker SD. Ethical Guidelines for Publishing in the Journal of Cachexia, Sarcopenia and Muscle Clinical Reports. JCSM Clinical Reports 2016. [DOI: 10.17987/jcsm-cr.v1i1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThis article details the principles of ethical authorship and publishing in the Journal of Cachexia, Sarcopenia and Muscle Clinical Reports (JCSM Clinical Reports). At the time of submission to JCSM Clinical Reports, the corresponding author, on behalf of all co-authors, needs to certify adherence to these principles. The principles are obtained below: All authors listed on a manuscript considered for publication have approved its submission and (if accepted) publication as provided to JCSM Clinical Reports;No person having a right to be recognized as author has been omitted from the list of authors on the submitted manuscript;The submitted work is original and is neither under consideration elsewhere nor has it been published previously in whole or in part other than in abstract form;All authors certify that the work is original and does not contain excessive overlap with prior or contemporaneous publication elsewhere, and where the publication reports on cohorts, trials, or data that have been reported on before these other publications must be referenced;All original research work are approved by the relevant bodies such as institutional review boards or ethics committees;All conflicts of interest, financial or otherwise, that may affect the authors' ability to present data objectively, and relevant sources of funding have been duly declared in the manuscript;The manuscript in its published form will be maintained on the servers of JCSM Clinical Reports as a valid publication only as long as all statements in the guidelines on ethical publishing remain true; andIf any of the aforementioned statements ceases to be true, the authors have a duty to notify the Editors of JCSM Clinical Reports as soon as possible so that the available information regarding the published article can be updated and/or the manuscript can be withdrawn.
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Trippel TD, Ebner N, Von Haehling S. The patient above all else: Introducing JCSM Clinical Reports A legitimate crown princess, daugther of the Journal of Cachexia, Sarcopenia and Muscle. JCSM Clinical Reports 2016. [DOI: 10.17987/jcsm-cr.v1i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The patient above all else: Introducing JCSM Clinical Reports
A legitimate crown princess, daugther of the Journal of Cachexia, Sarcopenia and Muscle
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Anker MS, Ebner N, Hildebrandt B, Springer J, Sinn M, Riess H, Anker SD, Landmesser U, Haverkamp W, von Haehling S. Resting heart rate is an independent predictor of death in patients with colorectal, pancreatic, and non-small cell lung cancer: results of a prospective cardiovascular long-term study. Eur J Heart Fail 2016; 18:1524-1534. [DOI: 10.1002/ejhf.670] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/28/2016] [Accepted: 09/02/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Markus S. Anker
- Charité-Campus Benjamin Franklin (CBF); Department of Cardiology; Berlin Germany
| | - Nicole Ebner
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Bert Hildebrandt
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Jochen Springer
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Marianne Sinn
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Hanno Riess
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Stefan D. Anker
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Ulf Landmesser
- Charité-Campus Benjamin Franklin (CBF); Department of Cardiology; Berlin Germany
| | - Wilhelm Haverkamp
- Charité-Campus Virchow-Klinikum (CVK); Department of Cardiology; Berlin Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
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Dos Santos MR, Saitoh M, Ebner N, Valentova M, Konishi M, Ishida J, Emami A, Springer J, Sandek A, Doehner W, Anker SD, von Haehling S. Sarcopenia and Endothelial Function in Patients With Chronic Heart Failure: Results From the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF). J Am Med Dir Assoc 2016; 18:240-245. [PMID: 27816483 DOI: 10.1016/j.jamda.2016.09.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/12/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Skeletal muscle wasting, also known as sarcopenia, has recently been identified as a serious comorbidity in patients with heart failure (HF). We aimed to assess the impact of sarcopenia on endothelial dysfunction in patients with HF with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). DESIGN Cross-sectional study. SETTING Ambulatory patients with HF were recruited at Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. PARTICIPANTS We assessed peripheral blood flow (arm and leg) in 228 patients with HF and 32 controls who participated in the Studies Investigating Comorbidities Aggravating HF (SICA-HF). MEASUREMENTS The appendicular skeletal muscle mass of the arms and the legs combined was assessed by dual energy x-ray absorptiometry (DEXA). Sarcopenia was defined as the appendicular muscle mass two standard deviations below the mean of a healthy reference group of adults aged 18 to 40 years, as suggested for the diagnosis of muscle wasting in healthy aging. All patients underwent a 6-minute walk test and spiroergometry testing. Forearm and leg blood flow were measured by venous occlusion plethysmography. Peak blood flow was assessed after a period of ischemia in the limbs to test endothelial function. RESULTS Sarcopenia was identified in 37 patients (19.5%). Patients with sarcopenia presented with lower baseline forearm blood flow (2.30 ± 1.21 vs. 3.06 ± 1.49 vs. 4.00 ± 1.66 mL min-1 100 mL-1; P = .02) than those without sarcopenia or controls. The group of patients with sarcopenia showed similar baseline leg blood flow (2.06 ± 1.62 vs. 2.39 ± 1.39 mL min-1 100 mL-1; P = .11) to those without but lower values when compared to controls (2.06 ± 1.62 vs. 2.99 ± 1.28 mL min-1 100 mL-1; P = .03). In addition, patients with and without sarcopenia presented with lower peak flow in the forearm when compared to controls (18.37 ± 7.07 vs. 22.19 ± 8.64 vs. 33.63 ± 8.57 mL min-1 100 mL-1; P < .001). A similar result was observed in the leg (10.89 ± 5.61 vs. 14.66 ± 7.19 vs. 21.37 ± 13.16 mL min-1 100 mL-1; P < .001). Peak flow in the forearm showed a significant correlation with exercise capacity (relative peak VO2: R = 0.47; P < .001; absolute peak VO2: R = 0.35; P < .001; and 6-min walk distance: R = 0.20; P < .01). Similar correlations were observed between peak flow in the leg and exercise capacity (absolute peak VO2: R = 0.42, P < .001; relative peak VO2: R = 0.41, P < .001; and 6-min walk test: R = 0.33; P < .001). Logistic regression showed peak flow in the leg to be independently associated with the 6-min walk distance adjusted for age, hemoglobin level, albumin, creatinine, presence of sarcopenia, and coronary artery disease (hazard ratio, 0.903; 95% confidence interval, 0.835-0.976; P = .01). CONCLUSION Patients with HF associated with sarcopenia have impaired endothelial function. Lower vasodilatation had a negative impact on exercise capacity, particularly prevalent in patients with sarcopenia.
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Affiliation(s)
- Marcelo R Dos Santos
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany; Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Masakazu Saitoh
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Miroslava Valentova
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Masaaki Konishi
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Junichi Ishida
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Amir Emami
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Anja Sandek
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
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Abstract
Research and development of new drugs requires both long time and high costs, whereas safety and tolerability profiles make the success rate of approval very low. Drug repurposing, applying known drugs and compounds to new indications, has been noted recently as a cost-effective and time-unconsuming way in developing new drugs, because they have already been proven safe in humans. In this review, we discuss drug repurposing of approved cardiovascular drugs, such as aspirin, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, cardiac glycosides and statins. Regarding anti-tumor activities of these agents, a number of experimental studies have demonstrated promising pleiotropic properties, whereas all clinical trials have not shown expected results. In pathological conditions other than cancer, repurposing of cardiovascular drugs is also expanding. Numerous experimental studies have reported possibilities of drug repurposing in this field and some of them have been tried for new indications (‘bench to bedside’), while unexpected results of clinical studies have given hints for drug repurposing and some unknown mechanisms of action have been demonstrated by experimental studies (‘bedside to bench’). The future perspective of experimental and clinical studies using cardiovascular drugs are also discussed.
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Affiliation(s)
- Junichi Ishida
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Masaaki Konishi
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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von Haehling S, Ebner N, Anker SD. Moving upwards - the journal of cachexia, sarcopenia and muscle in 2016. J Cachexia Sarcopenia Muscle 2016; 7:391-5. [PMID: 27625918 PMCID: PMC5011813 DOI: 10.1002/jcsm.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Stephan von Haehling
- Innovative Clinical Trial, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Nicole Ebner
- Innovative Clinical Trial, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
| | - Stefan D Anker
- Innovative Clinical Trial, Department of Cardiology and Pneumology University of Göttingen Medical School Göttingen Germany
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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 JG, Lainscak M, Anker SD, von Haehling S. Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life. Int J Cardiol 2016; 222:41-46. [PMID: 27454614 DOI: 10.1016/j.ijcard.2016.07.135] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 12/13/2022]
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 18-40years. 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±145m, p=0.003) and showed lower absolute peak oxygen consumption (1579±474 vs. 1211±442mL/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 1s (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.
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Affiliation(s)
- Tarek Bekfani
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany.
| | | | - Daniel A Morris
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Nicole Ebner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Miroslava Valentova
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany; Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic.
| | - Lisa Steinbeck
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Rolf Wachter
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Sebastian Elsner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Veronika Sliziuk
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland.
| | - Anja Sandek
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Wolfram Doehner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
| | - John G Cleland
- University of Hull, Department of Cardiology, Hull, United Kingdom.
| | - Mitja Lainscak
- Golnik University, Department of Cardiology, Golnik, Slovenia.
| | - Stefan D Anker
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Stephan von Haehling
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
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Valentova M, von Haehling S, Bauditz J, Doehner W, Ebner N, Bekfani T, Elsner S, Sliziuk V, Scherbakov N, Murín J, Anker SD, Sandek A. Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure. Eur Heart J 2016. [PMID: 26865478 DOI: 10.1093/eurheartj/ehw008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia. METHODS AND RESULTS Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment. CONCLUSION Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship.
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Affiliation(s)
- Miroslava Valentova
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
| | - Juergen Bauditz
- Department of Gastroenterology, Charité Medical School, Campus Mitte, Berlin, Germany Center for Internal Medicine, Helios Clinic Zerbst/Anhalt, Zerbst, Germany
| | - Wolfram Doehner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Tarek Bekfani
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Sebastian Elsner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Veronika Sliziuk
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Nadja Scherbakov
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Ján Murín
- First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
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47
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Kube J, Ebner N, Jankowska EA, Rozentryt P, Cicoira M, Filippatos GS, Ponikowski P, Doehner W, Anker SD, von Haehling S. The influence of confounders in the analysis of mid-regional pro-atrial natriuretic peptide in patients with chronic heart failure. Int J Cardiol 2016; 219:84-91. [PMID: 27288971 DOI: 10.1016/j.ijcard.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Natriuretic peptides play an important role in the diagnosis and risk stratification of patients with acute and chronic heart failure. Multiple studies have shown that these peptides are liable to the influence of individual factors. For N-terminal-pro-B-type natriuretic peptide (NT-proBNP) some of these confounding factors have been evaluated over the years such as age, gender, New York Heart Association (NYHA) class and body mass index (BMI). The aim of this study was to establish confounding factors of mid-regional pro-atrial natriuretic peptide (MR-proANP) assessment. METHODS AND RESULTS We studied 684 patients (94% male, age 61.2±11.2, left ventricular ejection fraction [LVEF]<35%-45%, NYHA class (I/II/III/IV: 8.4/45.8/39.5/6.3%), ischaemic aetiology 71%, body mass index [BMI] 26.5±4.3kg/m(2), mean MR-proANP 296.0±281.0pmol/L, mean NT-proBNP 2792.0±5328.6pg/mL, mean creatinine level 110.2±38.0μmol/L and mean haemoglobin 13.9±1.5g/dL) with clinically stable chronic heart failure. MR-proANP levels increased with increasing NYHA class (p<0.0001) and an increasing BMI category was associated with decreasing values of MR-proANP (p<0.0001). We found MR-proANP to be independently associated with BMI, creatinine, ischaemic aetiology, LVEF and NYHA class. Meanwhile, NT-proBNP was independently associated with BMI, creatinine, haemoglobin, LVEF and NYHA class. CONCLUSION MR-proANP is subject to the almost identical influencing factors like NT-proBNP. The effects of anaemia warrant further study.
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Affiliation(s)
- Jennifer Kube
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Rozentryt
- 3rd Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | | | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Wolfram Doehner
- Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany; Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
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Ebner N, von Haehling S. Iron and Exercise in Heart Failure: How to Assess Relevant Changes? Rev Esp Cardiol (Engl Ed) 2016; 69:237-238. [PMID: 26839057 DOI: 10.1016/j.rec.2015.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/05/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Nicole Ebner
- Department of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine, Göttingen, Germany
| | - Stephan von Haehling
- Department of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine, Göttingen, Germany.
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49
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Scherbakov N, Knops M, Ebner N, Valentova M, Sandek A, Grittner U, Dahinden P, Hettwer S, Schefold JC, von Haehling S, Anker SD, Joebges M, Doehner W. Evaluation of C-terminal Agrin Fragment as a marker of muscle wasting in patients after acute stroke during early rehabilitation. J Cachexia Sarcopenia Muscle 2016; 7:60-7. [PMID: 27066319 PMCID: PMC4799857 DOI: 10.1002/jcsm.12068] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 07/15/2015] [Accepted: 07/31/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND C-terminal Agrin Fragment (CAF) has been proposed as a novel biomarker for sarcopenia originating from the degeneration of the neuromuscular junctions. In patients with stroke muscle wasting is a common observation that predicts functional outcome. We aimed to evaluate agrin sub-fragment CAF22 as a marker of decreased muscle mass and physical performance in the early phase after acute stroke. METHODS Patients with acute ischaemic or haemorrhagic stroke (n = 123, mean age 70 ± 11 y, body mass index BMI 27.0 ± 4.9 kg/m(2)) admitted to inpatient rehabilitation were studied in comparison to 26 healthy controls of similar age and BMI. Functional assessments were performed at begin (23 ± 17 days post stroke) and at the end of the structured rehabilitation programme (49 ± 18 days post stroke) that included physical assessment, maximum hand grip strength, Rivermead motor assessment, and Barthel index. Body composition was assessed by bioelectrical impedance analysis (BIA). Serum levels of CAF22 were measured by ELISA. RESULTS CAF22 levels were elevated in stroke patients at admission (134.3 ± 52.3 pM) and showed incomplete recovery until discharge (118.2 ± 42.7 pM) compared to healthy controls (95.7 ± 31.8 pM, p < 0.001). Simple regression analyses revealed an association between CAF22 levels and parameters of physical performance, hand grip strength, and phase angle, a BIA derived measure of the muscle cellular integrity. Improvement of the handgrip strength of the paretic arm during rehabilitation was independently related to the recovery of CAF22 serum levels only in those patients who showed increased lean mass during the rehabilitation. CONCLUSIONS CAF22 serum profiles showed a dynamic elevation and recovery in the subacute phase after acute stroke. Further studies are needed to explore the potential of CAF22 as a serum marker to monitor the muscle status in patients after stroke.
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Affiliation(s)
- Nadja Scherbakov
- Center for Stroke Research CSB Charite Universitätsmedizin Berlin Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin Germany
| | - Michael Knops
- Center for Stroke Research CSB Charite Universitätsmedizin Berlin Germany
| | - Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medicine Göttingen Germany
| | - Miroslava Valentova
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medicine Göttingen Germany; 1st Department of Internal Medicine Comenius University Bratislava Slovak Republic
| | - Anja Sandek
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medicine Göttingen Germany
| | - Ulrike Grittner
- Center for Stroke Research CSB Charite Universitätsmedizin Berlin Germany
| | | | | | - Jörg C Schefold
- Department of Intensive Care Medicine Inselspital, University Hospital of Bern Switzerland
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medicine Göttingen Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medicine Göttingen Germany
| | | | - Wolfram Doehner
- Center for Stroke Research CSB Charite Universitätsmedizin Berlin Germany; German Centre for Cardiovascular Research (DZHK), partner site Berlin Germany; Department of Cardiology Charite Universitätsmedizin Berlin Germany
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50
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Abstract
This article highlights pre-clinical and clinical studies into the field of wasting disorders that were presented at the 8th Cachexia Conference held in Paris, France December 2015. This year some interesting results of clinical trials and different new therapeutic targets were shown. This article presents the biological and clinical significance of different markers and new drugs for the treatment of skeletal muscle wasting. Effective treatments of cachexia and wasting disorders are urgently needed in order to improve the patients' quality of life and their survival.
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Affiliation(s)
- Nicole Ebner
- University Medical Center Goettingen Department of Cardiology and Pneumology, Innovative Clinical Trials Goettingen Germany
| | - Stephan von Haehling
- University Medical Center Goettingen Department of Cardiology and Pneumology, Innovative Clinical Trials Goettingen Germany
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