The challenge of frailty and sarcopenia in heart failure with preserved ejection fraction

Abstract

Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to stressors. Frailty is often accompanied by heart failure with preserved ejection fraction (HFpEF), and frailty is likely to affect its clinical features and outcomes. Frail patients with HFpEF are frequently associated with sarcopenia (ie, muscle loss and weakness), which is a major component of the pathophysiology of frailty. Sarcopenia is a systemic skeletal muscle disease that impairs the function of limb skeletal muscles, as well as respiratory muscles, and this results in further functional decline. In addition, sarcopenia may contribute to cardiovascular remodelling and dysfunction, leading to the development of HFpEF through several metabolic and endocrine abnormalities. Although there is no established strategy for frail patients with HFpEF, a multidisciplinary approach, including various types of muscular training and nutritional intervention, may provide beneficial effects for these patients.

Heart failure assessed based on plasma B-type natriuretic peptide (BNP) levels negatively impacts activity of daily living in patients with hip fracture

“…Moreover, the characteristics of the patients with third tertile plasma BNP appear to be consistent with the characteristics of elderly heart failure patients. [ 30 ] On the other hand, there was no difference in motor FIM at admission between the first and third tertile groups. This is likely due to the patients’ inability to move immediately after hip fracture, irrespective of the presence of heart failure.…”

Sarcopenia in Cirrhosis: Looking Beyond the Skeletal Muscle Loss to See the Systemic Disease

“…An increase in adipose tissue further contributes to increased systemic inflammation and leads to decreased levels of adiponectin . Adiponectin is cardioprotective, and low levels lead to increased myocardial oxidative stress and modulation of intracellular calcium‐handling regulatory proteins .…”

Role of Human Body Composition Analysis and Malnutrition Risk Questionnaire in the Assessment of Nutritional Status of Patients With Initially Diagnosed Crohn's Disease

“…Sarcopenia can be diagnosed when the changes in body composition and muscular mass decrease cause the muscular strength decline. Studies have found that patients with chronic diseases (such as chronic obstructive pulmonary disease, heart disease, digestive tract cancer, hepatic cirrhosis, diabetes, or chronic renal insufficiency) usually have sarcopenia which will affect the outcome of chronic diseases (3)(4)(5)(6)(7). Recently, the parameters related to the human muscular mass and muscular strength are integrated into many diagnostic criteria for malnutrition (8).…”