scholarly journals Metabolic frailty in malnourished heart failure patients

2016 ◽  
Vol 68 (2) ◽  
Author(s):  
Alessandra Gualco ◽  
Cristina Opasich ◽  
Silvia Brazzo ◽  
Franco Cobelli ◽  
Evasio Pasini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Food Intake ◽  
Nitrogen Balance ◽  
Nyha Class ◽  
Nutritional Supplement ◽  
Anthropometric Parameters ◽  
Cardiac Cachexia ◽  
Proteins Metabolism ◽  
Additional Therapy

Muscular wasting (MW) and cardiac cachexia (CC) are often present in patients with chronic heart failure (HF). Aim: To identify whether MW and CC are due to malnutrition or impairment of protein metabolism in HF patients. Material and Method: In 78 clinically stable HF patients (NYHA class II-III), aged from 32 to 89 years, we measured anthropometrical parameters and nutritional habits. In the identified 35 malnourished patients, we also measured: insulin resistance, gluconeogenetic amino acids blood concentration and nitrogen balance. Results: Seventy-five patients had eating-related symptoms. However we found significant nutritional impairment in 35 patients only. In addition, these 35 patients had: 1) significant increase of blood Alanine independently from both presence of insulin resistance or food intake reduction and 2) positive nitrogen balance. Conclusion: Food intake is not impaired in CHF patients. In spite of normal food intake, 35 of 78 patients had nutritional impairment with reduced anthropometric parameters and increased blood Alanine. These findings show alteration of proteins metabolism with proteolysis. We believe that specific physical training with nutritional supplement can be an additional therapy able to prevent protein disarrangement in CHF patients.

scholarly journals Circulating ghrelin in thyroid dysfunction is related to insulin resistance and not to hunger, food intake or anthropometric changes

2005 ◽  
Vol 153 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Olga Giménez-Palop ◽  
Gabriel Giménez-Pérez ◽  
Dídac Mauricio ◽  
Eugenio Berlanga ◽  
Neus Potau ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Energy Balance ◽  
Food Intake ◽  
Thyroid Dysfunction ◽  
Calorie Intake ◽  
Positive Energy ◽  
Control Group ◽  
Independent Data ◽  
Anthropometric Parameters ◽  
Before And After

Objective: Ghrelin is a gastric peptide that plays a role in appetite stimulation, energy balance and possibly in insulin resistance. Hyperthyroidism is a situation where negative energy balance and insulin resistance coexist, while in hypothyroidism a positive energy balance and normal insulin sensitivity predominate. We investigated ghrelin levels and their relationship with hunger, food intake and both anthropometric and insulin resistance parameters in patients with thyroid dysfunction. Design and methods:We studied 24 hyperthyroid and 17 hypothyroid patients before and after normalisation of thyroid hormone levels and their respective body mass index (BMI)-matched control group. We measured plasma ghrelin levels, homeostasis model assessment of insulin resistance (HOMA-IR) index, a hunger score, mean three-day calorie intake and anthropometric parameters. Results: In hyperthyroidism, HOMA-IR index was higher (3.21 ± 0.60 vs 1.67 ± 0.15mMmU/l; P = 0.014, t test for independent data) and ghrelin levels were lower (463.6 ± 36.4 vs 561.1 ± 32.1 pg/ml; P = 0.041, Mann–Whitney U-test) than in its control group and both normalised after treatment (HOMA-IR: 2.28 ± 0.38mMmU/l; P = 0.106, t test for independent data, and ghrelin: 539.7 ± 45.4 pg/ml; P = 0.549, Mann–Whitney U-test). Glucose, as a component of HOMA-IR index was the only predictor for ghrelin levels (β = −0.415, P = 0.044, stepwise multiple regression analysis). In hypothyroidism, HOMA-IR index and ghrelin levels were similar to those in its control group both before and after treatment. In both thyroid dysfunction states, no correlations were observed between changes in ghrelin levels and in free T4, free T3, anthropometric parameters, total calorie intake and hunger score. Conclusions: In thyroid dysfunction states, ghrelin levels seemed to be in relation to insulin resistance and not to energy balance and food intake regulation, as seen in other physiological and pathological states.

scholarly journals Serum concentration of visfatin is decreased in patients with chronic heart failure.

2012 ◽  
Vol 59 (3) ◽  
Author(s):  
Ewa Straburzyńska-Migaj ◽  
Lucja Pilaczyńska-Szcześniak ◽  
Alicja Nowak ◽  
Anna Straburzyńska-Lupa ◽  
Ewa Sliwicka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Left Ventricular Systolic Dysfunction ◽  
Nyha Class ◽  
Cardiopulmonary Exercise Testing ◽  
Resistance Index ◽  
Hdl Cholesterol ◽  
Left Ventricular ◽  
Model Assessment ◽  
Healthy Controls

There is an increasing interest in the role of adipocytokines in cardiovascular pathophysiology. The aim of the study was to compare visfatin levels, a novel adipokine, in patients with heart failure (HF) due to the left ventricular systolic dysfunction with those in age- and body mass index (BMI) - matched healthy controls in relation to the parameters of glucose metabolism and high sensitivity C-reactive protein (hsCRP) levels. The study population consisted of 28 males with systolic HF referred for cardiopulmonary exercise testing, divided into two subgroups based on their NYHA class (HF patients NYHA(I+II), n=17, and HF patients NYHA(III+IV,) n=11), and 23 controls. The following indices were measured in a serum samples: visfatin, hsCRP, glucose and lipid metabolism parameters, and the insulin resistance index HOMA(IR) (homeostasis model assessment insulin resistance) was calculated. Concentrations of visfatin and high-density lipoprotein cholesterol (HDL-cholesterol) in the HF subjects were significantly lower (p≤0.01) than in controls. The Kruskal-Wallis test showed significant differences between three groups (controls and both subgroups of heart failure patients) in mean levels of visfatin, hsCRP, glucose, HOMA(IR) and HDL-cholesterol. Serum visfatin concentrations in patients with systolic HF, particularly with more advanced NYHA classes, are significantly lower in comparison to healthy controls and are independent of age or anthropometric and metabolic parameters.

Abstract 2372: Clinical And Metabolic Effects Of Six Months Testosterone Treatment In Elderly Female Patients With Chronic Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
G caminiti ◽  
R karam ◽  
M volterrani ◽  
G marazzi ◽  
M miceli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Chronic Heart Failure ◽  
Muscle Strength ◽  
Exercise Capacity ◽  
Nyha Class ◽  
Female Patients ◽  
Elderly Female ◽  
Testosterone Administration ◽  
To Receive

Background: Patients with chronic heart failure (CHF) show muscle mass wasting and decreased exercise capacity. Testosterone supplementation improves several clinical and metabolic parameters in male CHF subjects. No studies have evaluated the effects of long-term testosterone administration on female patients with CHF. Aim: To assess the effect of a 6 months testosterone administration on exercise capacity, muscle strength, and insulin resistance in female patients with advanced CHF. Methods: Thirty-two elderly female patients (pts) with stable CHF, mean age 68,6 ± 7, ejection fraction 32,9 ± 6, NYHA class III, were enrolled. Of these, 20 were randomized to receive testosterone therapy (T) (through transdermal patch) and 12 to receive placebo (P), both on top of maximal medical therapy. At baseline, at three and after 6 months patients underwent echocardiogram, cardiopulmonary test, 6-minute walking test (6MWT), quadriceps maximal isometric voluntary contraction(MVC) and peaktorque (PT) and HOMA index assesment. Results: VO2 and distance walked at 6MWT significantly improved in T group from baseline both at three (+20%; +36% respectively) and six months (+28%; 41% respectively) while were unchanged in the P group. At six months Patients of T group had a significantly higher increase of both MVC and PT than P group. HOMA-R was significantly reduced (− 15% vs +5%; p < 0.05) and HDL-cholesterol levels were increased (+22% vs p < 0.05).in T group respect to P. NYHA class improved (from III to II) in 7/20 pts of T group and 2/12 of P group. Increase in free testosterone levels were significantly related to improvement in VO2 peak (r 0,42; p 0.032). No significant echocardiographic changes were observed in both groups. No side effects were observed. Two patients of both group were hospitalizes for HF recurrence. Conclusion: Testosterone supplementation improves exercise tolerance, muscle strength, and insulin resistance in women with advanced CHF. Testosterone seem to be an effective and safe therapy for CHF elderly female subjects.

scholarly journals Prevalence and effect of cardiac cachexia in advanced heart failure patients living in northern ireland

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
M Carson ◽  
J Reid ◽  
L Hill ◽  
L Dixon ◽  
P Donnelly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Northern Ireland ◽  
Muscle Mass ◽  
Nyha Class ◽  
Advanced Heart Failure ◽  
Class Iii ◽  
Upper Arm ◽  
Cardiac Cachexia

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Northern Ireland Chest Heart and Stroke Background/Introduction: Cardiac cachexia (CC) is a multifactorial wasting syndrome, resulting in significant weight loss and reduction in muscle mass. This is reflected in a detrimental effect on the patients’ physical condition, quality of life and increases the patient’s risk of premature death. Nonetheless, cardiac cachexia remains frequently unrecognised in clinical practice and therefore understudied. Purpose To determine the prevalence and effect of cardiac cachexia in 200 patients with advanced heart failure (NYHA class III-IV) living in Northern Ireland. Methods A mixed methods cross sectional study of patients recruited from a regional heart failure centre. A total of 200 patients with NYHA class III-IV heart failure were consented, enrolled and detailed data collected from their records. Anthropometric measures were taken (i.e. measures of lean muscle mass and fat tissue) and each individual completed three validated questionnaires - EQ-5D-5L (quality of life), FACIT-Fatigue and FAACT (various wellbeing subscales). Results This population was predominately male (65.5%), with an average age of 74.4 years. Of the 200 NYHA class III-IV patients recruited, 30 were identified as cachectic (15%) Physically, cachectic patients were approximately 25 kg lighter than non-cachectic patients (p &lt; 0.01) with an average BMI of 21.8 ± 4.4. The cachectic group showed significant reductions in mid-upper arm circumference (p &lt; 0.01), skinfold thickness (p &lt; 0.01) and upper arm fat area (p &lt; 0.01), in comparison to the non-cachectic group. Measures of muscle mass were reduced, for example upper arm muscle circumference and area (p &lt; 0.01), as well as grip strength (p &lt; 0.01 for both right and left hands). Quality of life results from the EQ-5D-5L [see figure part b)] indicated an overall reduction for the cachectic group (p = 0.047). Of the EQ-5D-5L subscales, mobility and ‘usual activities’ were significantly reduced (p = 0.02 and p &lt; 0.01 respectively), highlighting a significant change in the daily routine and ability of these patients. The FACIT-Fatigue questionnaire showed cachectic patients to be significantly more fatigued (p &lt; 0.01) [see figure part a)], whilst the FAACT demonstrated reduced physical wellbeing (p = 0.02) and greater issues with diet and appetite (p &lt; 0.01). Conclusions This is the first prevalence study of cardiac cachexia within Northern Ireland. The 15% prevalence rate shows that the syndrome is relatively common in the advanced heart failure population. Cardiac Cachexia has severe physical consequences, attributed to an individual’s weight loss in both fat and muscle tissue. Such changes may explain the subsequent decrease in mobility and the ability of these patients to conduct their ‘usual activities’. Increased fatigue, reduced physical wellbeing and issues with diet and appetite only intensify these dire physical effects. It is hoped that these results will highlight the impact of this syndrome and promote targeted interventions.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

Hormonal Changes and Catabolic/Anabolic Imbalance in Chronic Heart Failure and Their Importance for Cardiac Cachexia

Circulation ◽  
1997 ◽  
Vol 96 (2) ◽  
pp. 526-534 ◽  
Author(s):  
Stefan D. Anker ◽  
Tuan Peng Chua ◽  
Piotr Ponikowski ◽  
Derek Harrington ◽  
Jon W. Swan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Hormonal Changes ◽  
Cardiac Cachexia

scholarly journals Myeloperoxidase-Related Chlorination Activity Is Positively Associated with Circulating Ceruloplasmin in Chronic Heart Failure Patients: Relationship with Neurohormonal, Inflammatory, and Nutritional Parameters

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Aderville Cabassi ◽  
Simone Maurizio Binno ◽  
Stefano Tedeschi ◽  
Gallia Graiani ◽  
Cinzia Galizia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nitrosative Stress ◽  
Defense Mechanism ◽  
Nyha Class ◽  
Protein Nitration ◽  
Class Iii ◽  
Oxidative And Nitrosative Stress ◽  
Radical Production ◽  
Antioxidant Function ◽  
The Relationship

Rationale. Heart failure (HF) is accompanied by the development of an imbalance between oxygen- and nitric oxide-derived free radical production leading to protein nitration. Both chlorinating and peroxidase cycle of Myeloperoxidase (MPO) contribute to oxidative and nitrosative stress and are involved in tyrosine nitration of protein. Ceruloplasmin (Cp) has antioxidant function through its ferroxidase I (FeOxI) activity and has recently been proposed as a physiological defense mechanism against MPO inappropriate actions.Objective. We investigated the relationship between plasma MPO-related chlorinating activity, Cp and FeOxI, and nitrosative stress, inflammatory, neurohormonal, and nutritional biomarkers in HF patients.Methods and Results. In chronic HF patients (n=81, 76±9 years, NYHA Class II (26); Class III (29); Class IV (26)) and age-matched controls (n=17, 75±11 years, CTR), plasma MPO chlorinating activity, Cp, FeOxI, nitrated protein, free Malondialdehyde, BNP, norepinephrine, hsCRP, albumin, and prealbumin were measured. Plasma MPO chlorinating activity, Cp, BNP, norepinephrine, and hsCRP were increased in HF versus CTR. FeOxI, albumin, and prealbumin were decreased in HF. MPO-related chlorinating activity was positively related to Cp (r= 0.363,P<0.001), nitrated protein, hsCRP, and BNP and inversely to albumin.Conclusions. Plasma MPO chlorinated activity is increased in elderly chronic HF patients and positively associated with Cp, inflammatory, neurohormonal, and nitrosative parameters suggesting a role in HF progression.

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