title: Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life.
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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. Electronic address: Tarek.bekfani@charite.de.
authors.forename: Tarek
authors.initials: T
authors.lastname: Bekfani
authors.affiliation: University of Hull, Department of Cardiology, Hull, United Kingdom. Electronic address: Pierpaolo.Pellicori@hey.nhs.uk.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Pellicori
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: Daniel-Armando.Morris@charite.de.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Morris
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: nicole.ebner@med.uni-goettingen.de.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ebner
authors.affiliation: University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany; Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic. Electronic address: miroslava.valentova@med.uni-goettingen.de.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Valentova
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: lisa.steinbeck@gmx.de.
authors.forename: Lisa
authors.initials: L
authors.lastname: Steinbeck
authors.affiliation: University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: wachter@med.uni-goettingen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: sebastian.elsner@charite.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Elsner
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany. Electronic address: veronika.sliziuk@charite.de.
authors.forename: Veronika
authors.initials: V
authors.lastname: Sliziuk
authors.affiliation: Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland. Electronic address: joerg.schefold@insel.ch.
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
authors.affiliation: University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: anja.sandek@med.uni-goettingen.de.
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany. Electronic address: Wolfram.Doehner@charite.de.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.affiliation: University of Hull, Department of Cardiology, Hull, United Kingdom. Electronic address: J.G.Cleland@hull.ac.uk.
authors.forename: John G
authors.initials: JG
authors.lastname: Cleland
authors.affiliation: Golnik University, Department of Cardiology, Golnik, Slovenia. Electronic address: mitja.lainscak@guest.arnes.si.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: s.anker@cachexia.de.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany. Electronic address: stephan.von.haehling@web.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods; D005060:Europe / Q000453:epidemiology; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010101:Oxygen Consumption; D015995:Prevalence; D011788:Quality of Life; D055948:Sarcopenia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D012720:Severity of Illness Index; D000070857:Walk Test / Q000379:methods
keywords: Exercise capacity; Heart failure with preserved ejection fraction; Muscle wasting; Quality of life; Sarcopenia