Muscle mass, muscle strength, and functional capacity in patients with heart failure of Chagas disease and other aetiologies

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/m 2 (ALM/height 2) and handgrip strength cutoff 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 (VO 2) (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 VO 2 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 VO 2 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.

Inspiratory muscle endurance is similarly reduced in the early and late stages of chronic Chagas heart disease

“…A crosssectional study in which a sample of men with LVEF <40% compared patients with HF from Chagas disease with other patients with HF from other etiologies. CHD patients have lower handgrip strength values than ischemic and dilated cardiomyopathy patients but did not compare with a predicted value [39]. Previous studies demonstrates a reduced peripheral muscle strength by hand dynamometry in other populations of HF patients [40], and in our sample this reduction also appears, and although this strength did not differ between CHD-CC and CHD-HF groups, only CHD-HF group presented weakness.…”

A year in heart failure: an update of recent findings

“…It is the result of impaired homeostatic mechanisms and reduced resistance to stressors that might be the consequence of bone 65 and muscle wasting (sarcopenia) or cachexia, both of which have been shown to be independently associated with increased mortality 31,39,66 . Muscle wasting has been described across a vast spectrum of HF aetiologies including ischaemic cardiomyopathy and Chagas disease, 67 and the importance of more clinical and therapeutic action has been highlighted in recent years 63,64,68 . In a retrospective analysis of PARADIGM‐HF [Prospective comparison of angiotensin receptor‐neprilysin inhibitors with angiotensin‐converting enzyme inhibitors to Determine Impact on Global Mortality and morbidity in HF] and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure), 63% of patients with HF were considered frail, based on a Frailty Index > 0.21 62 .…”

“…(sarcopenia) or cachexia, both of which have been shown to be independently associated with increased mortality. 31,39,66 Muscle wasting has been described across a vast spectrum of HF aetiologies including ischaemic cardiomyopathy and Chagas disease, 67 and the importance of more clinical and therapeutic action has been highlighted in recent years. 63,64,68 In a retrospective analysis of PARADIGM…”