Sarcopenia: Inflammatory and Humoral Markers in Older Heart Failure Patients

Sangali, Tamirys Delazeri; Souza, Gabriela Corrêa; Ribeiro, Édina Caroline Ternus; Perry, Ingrid Dalira Schweigert

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Arquivos Brasileiros de Cardiologia

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Brasil

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Sumário

Original Article • Arq. Bras. Cardiol. 120 (7) • 2023 • https://doi.org/10.36660/abc.20220369 copy

Sarcopenia: Inflammatory and Humoral Markers in Older Heart Failure Patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Sarcopenia is highly prevalent in heart failure (HF) patients, and the involvement of biomarkers in its pathophysiology is suggested, but little has been studied concerning HF sarcopenic patients.

Objectives

To evaluate the association between inflammatory and humoral markers with sarcopenia, as well as the impact of sarcopenia on quality of life and functional capacity in older HF patients.

Methods

In this cross-sectional study, 90 outpatient HF patients, aged ≥ 60 years, were evaluated for sarcopenia (EWGSOP2 diagnostic criteria), inflammation (high-sensitive C-reactive protein [hs-CRP], Interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α]) and humoral markers (total testosterone and insulin-like growth factor-1 [IGF-1]), physical activity (International Physical Activity Questionnaire), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walk test). The adopted level of significance was p<0.05.

Results

Patients had a mean age of 69.4 ± 7.2 years, 67.8% were male, with left ventricular ejection fraction (LVEF) of 35.9 ± 11.9% and 22 (24.4%) were sarcopenic. Age (73.1 ± 8.1 and 68.3 ± 6.5 years; p= 0.006), body mass index (BMI) (23.1 ± 2.8 and 28.2 ± 4.2 kg/m²; p <0.001), and LVEF (29.9 ± 8.8 and 37.9 ± 12.1%; p= 0.005) were different between groups with and without sarcopenia, respectively. After adjusting for age, ethnicity, BMI, LVEF, and the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, sarcopenia was associated with higher serum levels of IL-6 and worse functional capacity.

Conclusion

In HF patients, sarcopenia was associated with IL-6 levels and functional capacity.

Sarcopenia; Biomarkers; Inflammation; Heart Failure

	All patients (n = 90)	Without sarcopenia (n =68)	With sarcopenia (n = 22)	p
Male	61 (67.8)	46 (67.6)	15 (68.2)	1.000
Age (years)	69.4 ± 7.2	68.3 ± 6.5	73.1 ± 8.1	0.006
Race
White	70 (77.8)	50 (73.5)	20 (90.9)
Not white	20 (22.2)	18 (26.5)	2 (9.1)	0.139
Heart Failure Etiology
Ischemic	26 (28.9)	19 (27.9)	7 (31.8)	0.584
Non-ischemic	24 (26.7)	20 (29.4)	4 (19.2)
Hypertensive	40 (44.4)	29 (42.6)	11 (50.0)
LVEF (%)	35.9 ± 11.9	37.9 ± 12.1	29.9 ± 8.8	0.005
NYHA Classification
I and II	70 (77.8)	55 (80.9)	15 (68.2)	0.244
III and IV	20 (22.2)	13 (19.1)	7 (31.8)
HFrEF	80 (88.9)	59 (86.8)	21 (95.5)	0.441
HFpEF	10 (11.1)	9 (13.2)	1 (4.5)
Medications
ACEI/ARB	84 (93.3)	67 (98.5)	17 (77.3)	0.003
Beta-blocker	85 (94.4)	65 (95.6)	20 (90.9)	0.592
Digitalis	28 (31.1)	20 (29.4)	8 (36.4)	0.728
Diuretics	83 (92.2)	62 (91.2)	21 (95.5)	1.000
Weight (kg)	72.4 ± 14.5	76.9 ± 13.6	58.6 ± 5.8	<0.001
BMI (kg/m²)	26.9 ± 4.5	28.2 ± 4.2	23.1 ± 2.8	<0.001
BMI Classification
Low weight	13 (14.4)	5 (7.4)	8 (36.4)*	<0.001
Eutrophic	31 (34.4)	20 (29.4)	11 (50.0)
Overweight	46 (51.1)	43 (63.2)*	3 (13.6)
CC Classification
<31 cm	3 (3.3)	0 (0.0)	3 (13.6)	0.013
≥31 cm	87 (96.7)	68 (100)	19 (86.4)
AMC Classification
Malnutrition	13 (14.4)	3 (4.4)	10 (45.5)	<0.001
Eutrophy	77 (85.6)	65 (95.6)	12 (54.5)
Comorbidities
SAH	63 (70.0)	50 (73.5)	13 (59.1)	0.309
Diabetes mellitus	33 (36.7)	25 (36.8)	8 (36.4)	1.000
Dyslipidemia	12 (13.3)	9 (13.2)	3 (13.6)	1.000
Physical activity level
Sedentary	22 (24.4)	16 (23.5)	6 (27.3)	0.931
Irregularly active A/B	56 (62.2)	43 (63.2)	13 (59.1)
Active	12 (13.3)	9 (13.2)	3 (13.6)
Six-minute walk test	366.7 ± 88.9	383.1 ± 78.9	316.4 ± 100.9	0.002
Quality of life
MLHFQ total score	23 (10 - 44)	19.5 (10 - 42.25)	37.5 (19.5 - 57.5)	0.033

	Without sarcopenia (n = 68)	With sarcopenia (n = 22)	p
hs-CRP (mg/L)	3.23 (1.78 - 6.42)	1.42 (0.81 - 10.8)	0.467
IGF-1 (ng/ml)	143.3 (97.9 - 177.3)	111.5 (87.8 - 165.4)	0.134
Total testosterone (ng/ml)
Female	0.11 (0.04 - 0.19)	0.02 (0.02 - 0.13)	0.304
Male	4.02 ± 1.49	4.16 ± 1.71	0.757
IL-6 (pg/mL)	1.49 (0.85 - 2.32)	2.26 (0.92 - 3.78)	0.062
TNF-α (pg/mL)	0.62 (0.48 - 1.04)	0.72 (0.47 - 1.22)	0.538

Variables	Univariate		Model 1		Model 2
Variables	PR (95% CI)	p	PR adjusted (95% CI)	p	PR adjusted (95% CI)	p
Age (years)	1.06 (1.02 – 1.11)	0.003	1.03 (0.98 – 1.09)	0.255	1.03 (0.98 – 1.08)	0.292
BMI (kg/m²)	0.79 (0.72 – 0.85)	<0.001	0.78 (0.70 – 0.87)	<0.001	0.77 (0.70 – 0.84)	<0.001
Race (%)
White	2.86 (0.73 – 11.2)	0.132	-	-	-	-
Not white	1.00
LVEF (%)	0.95 (0.92 – 0.98)	0.001	0.96 (0.94 – 0.99)	0.007	0.97 (0.94 – 1.00)	0.060
Use of ACEI/ARB	0.24 (0.14 – 0.42)	<0.001	0.60 (0.30 – 1.18)	0.141	0.95 (0.39 – 2.35)	0.919
hs-CRP (mg/L)	0.99 (0.96 – 1.03)	0.751	-	-	-	-
IGF-1 (mg/ml)	0.99 (0.98 - 1.00)	0.297	-	-	-	-
Total testosterone (ng/ml)	1.02 (0.86 - 1.20)	0.852	-	-	-	-
IL-6 (pg/mL)	1.15 (1.07 - 1.24)	<0.001	1.10 (1.02 - 1.18)	0.009	-	-
TNF-α (pg/mL)	1.08 (0.67 - 1.75)	0.752	-	-	-	-
IPAQ-s
Sedentary	1.09 (0.27 - 4.36)	0.902	-	-
Irregularly active B/A	0.93 (0.27 - 3.26)	0.908	-	-
Active	1.00		-	-
Six-minute walk test
Normal performance	1.00		-	-	1.00
Low performance	2.97 (1.27 - 6.96)	0.012	-	-	3.06 (1.50 – 6.26)	0.002

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