Sarcopenia in heart failure with reduced ejection fraction

Aims: To evaluate the prevalence of pre-sarcopenia and sarcopenia and their relationship with clinical variables, physical activity, quality of life, and diet in patients with heart failure with reduced left ventricular ejection fraction (HFrEF).

Methods: We performed a cross-sectional study in patients with HFrEF and matched controls. Clinical, laboratory analysis, dual-emission X-ray densitometry, handgrip strength, and physical activity level questionnaire assessments were performed. Echocardiography, quality of life, gait speed, and 24-hour nutritional recall questionnaire were also analyzed. Pre-sarcopenia and sarcopenia were defined according to the European Working Group on Sarcopenia in Older People with the cut-off points of the Foundation for the National Institute of Health.

Results: 79 patients and 143 controls were enrolled. Pre-sarcopenia was found in 30.4%, and sarcopenia in 10.1% of the patients. Pre-sarcopenic patients were older and shorter, and had more fractures, higher calcemia, and creatinine (P < 0.05). Sarcopenic patients were older and had higher creatinine and TSH (P < 0.05). After multiple logistic regression analysis, only age was associated with pre-sarcopenia (OR: 1.046; CI 1.004-1.095; P = 0.04) and SP (OR: 1.119; CI 1.039-1.229; P = 0.008). Women with HFrEF presented higher lean mass than controls (P < 0.001), but were weaker (P < 0.001), while men presented lower lean mass (P < 0.001). Low gait speed was associated with right ventricular dysfunction (P = 0.016) and lower left ventricular ejection fraction (P = 0.037).

Conclusion: Pre-sarcopenia and sarcopenia were associated with aging. Despite having higher lean mass, women with HFrEF were weaker. Low gait speed was associated with biventricular systolic dysfunction.