Effect of Electrical Muscle Stimulation on the Reduction of Muscle Volume Loss in Acute Heart Failure Patients

Abstract

Electrical muscle stimulation (EMS) is expected to be considered as an add-on therapy for the usual rehabilitation of patients with chronic heart failure (HF). However, it remains unclear whether EMS can reduce muscle volume loss in patients with acute HF (AHF) immediately after hospitalization. Therefore, the aim of this study was to investigate if EMS could reduce the lower-limb muscle volume loss in patients with AHF. In this single-center, retrospective, observational study, lower-limb skeletal muscle volume, quadriceps muscle layer thickness, and clinical events (worsening HF or kidney function) were evaluated in 45 patients with AHF (mean age, 77.4 ± 11.6 years, 31 males). All patients underwent EMS on the right leg, in addition to usual rehabilitation, for 20 minutes per day, 5 days per week, for 2 weeks. A two-factor (time × leg) analysis of variance was performed to compare the difference between the right leg (usual rehabilitation and EMS) and left leg (usual rehabilitation only). The skeletal muscle mass decreased by 11.6% ± 19.7% from baseline in the right leg and by 20.4% ± 16.1% in the left leg (interaction; F = 4.54, P = 0.036). The quadriceps muscle layer thickness decreased by 10.2% ± 7.1% from baseline in the right leg and by 13.5% ± 6.0% in the left leg (interaction; F = 10.50, P = 0.002). No clinical events were related to EMS. Results showed that EMS combined with usual rehabilitation for patients with AHF has the potential to inhibit muscle volume loss.

Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations

“…One non-controlled cohort study of 10 weeks ( 14 ) and a further non-randomized clinical trial of 4 months ( 38 ) included solely participants with chronic heart failure ( 14 , 38 ). Matsuo et al ( 23 ) and Tanaka et al ( 36 ) selected acute heart failure as an eligibility criterion and applied 10 and 14 days of B-SES during hospitalization in their moderate quality studies. In parallel, about 50% of the critically ill patients of Nakamura et al ( 25 , 26 ) and 70% of the hemodialysis patients included in the moderate quality RCT of Homma et al ( 16 ) reported heart failure, cardiopulmonary arrest or had a history of ischemic heart disease ( 16 ).…”

“…Two of the studies included hospitalized cohorts with end-stage diabetes kidney disease ( 37 ) or diabetic ulcers undergoing minor amputation ( 18 ). Additionally, four other trials did not focus on, but included a large proportion of participants with NIDDM ( 16 , 22 , 23 , 34 ). Of importance, a further three moderate to high quality RCTs ( 12 , 20 , 28 ) focused on cohorts with the Metabolic Syndrome (MetS) applying WB-EMS for 3–6 months.…”

Outcomes Addressed by Whole-Body Electromyostimulation and Belt Electrode-Skeletal Muscle Electrical Stimulation Trials in Middle Aged to Older Adults – an Evidence Map

“…More than two thirds of the studies/projects reported changes body composition parameters as primary, secondary or tertiary outcome. Although difficult to conclude 8 , about 14 studies considered changes in body composition and anthropometry at least as a core outcome [21,23,27,39,44,49,50,53,54,58,59,63,68,77] (Figure 3 31,39,44,57,75,92], one study [37] relied on the caliper method and a further study [53] determined changes in thigh and calf circumference.…”

“…Apart from total body fat, several studies determined trunk, abdominal, or visceral fat mass/rate by BIA [46,65], DXA [19,31,39,41] or CT [68] or, less sophisticated, by waist circumference [19, 21,39,65,71,75,94]. Eleven studies focus on local muscle parameters (muscle thickness, cross-sectional area, crosssectional volume) predominately at the mid-thigh/quadriceps site [23,27,29,46,54,58,59,63,68,83,86], calf [23] or upper arm [27] applying either ultrasound (US) [23,27,29,63,86], computed tomography (CT) [58,59,68] or magnetic resonance imaging (MRI) [46,83] techniques. Of relevance, five of the studies consider thigh muscle layer thickness (by US) as a primary outcome [23,54,58,59,63].…”

“…Most studies/projects applied BIA[12,21,23,27,28,30,49,50,54,65,[67][68][69]71,74,[76][77][78]83,86,91] for the assessment of body composition. The minority of studies used DXA-technique, [19,…”