Sarcopenia and Endothelial Function in Patients With Chronic Heart Failure: Results From the Studies Investigating Comorbidities Aggravating Heart Failure (SICA-HF).
OBJECTIVE
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).


METHODS
Cross-sectional study.


METHODS
Ambulatory patients with HF were recruited at Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.


METHODS
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).


METHODS
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-1100 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-1100 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-1100 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-1100 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-1100 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).


CONCLUSIONS
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.
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.
Marcelo R
MR
Dos Santos
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Masakazu
M
Saitoh
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Nicole
N
Ebner
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Miroslava
M
Valentova
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Masaaki
M
Konishi
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Junichi
J
Ishida
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Amir
A
Emami
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Jochen
J
Springer
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Anja
A
Sandek
Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
Wolfram
W
Doehner
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany.
Stefan D
SD
Anker
Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany. Electronic address: stephan.von.haehling@web.de.
Stephan
S
von Haehling
D000368:Aged; D001604:Berlin; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D055948:Sarcopenia / Q000503:physiopathology
Heart failure; endothelial dysfunction; muscle wasting; sarcopenia