Sympatho-Vagal Imbalance is Associated with Sarcopenia in Male Patients with Heart Failure

Author(s)

Peixoto da Fonseca, Guilherme Wesley ^[1] ; dos Santos, Marcelo Rodrigues ^[1] ; de Souza, Francis Ribeiro ^[1] ; da Costa, Marcel Jose A. ^[1] ; von Haehling, Stephan ^[2] ; Takayama, Liliam ^[3] ; Pereira, Rosa Maria R. ^[3] ; Negrao, Carlos Eduardo ^[1] ; Anker, Stefan D. ^[2] ; de Nazare Nunes Alves, Maria Janieire ^[1]

Affiliation

^[1] Inst Coracao InCor, Sao Paulo, SP - Brazil

^[2] Univ Gottingen, Med Ctr, Dept Cardiol & Pneumol, Gottingen - Germany

^[3] Univ Sao Paulo, Fac Med, Lab Metab Osseo, Div Reumatol, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: Arquivos Brasileiros de Cardiologia; v. 112, n. 6, p. 739-746, JUN 2019.
• Web of Science Citations: 2

Abstract

Abstract Background: Resting sympathetic hyperactivity and impaired parasympathetic reactivation after exercise have been described in patients with heart failure (HF). However, the association of these autonomic changes in patients with HF and sarcopenia is unknown. Objective: The aim of this study was to evaluate the impact of autonomic modulation on sarcopenia in male patients with HF. Methods: We enrolled 116 male patients with HF and left ventricular ejection fraction < 40%. All patients underwent a maximal cardiopulmonary exercise testing. Maximal heart rate was recorded and delta heart rate recovery (∆HRR) was assessed at 1st and 2nd minutes after exercise. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography. Dual-energy X-ray absorptiometry was used to measure body composition and sarcopenia was defined by the sum of appendicular lean muscle mass (ALM) divided by height in meters squared and handgrip strength. Results: Sarcopenia was identified in 33 patients (28%). Patients with sarcopenia had higher MSNA than those without (47 [41-52] vs. 40 [34-48] bursts/min, p = 0.028). Sarcopenic patients showed lower ∆HRR at 1st (15 [10-21] vs. 22 [16-30] beats/min, p < 0.001) and 2nd min (25 [19-39] vs. 35 [24-48] beats/min, p = 0.017) than non-sarcopenic. There was a positive correlation between ALM and ∆HRR at 1st (r = 0.26, p = 0.008) and 2nd min (r = 0.25, p = 0.012). We observed a negative correlation between ALM and MSNA (r = -0.29, p = 0.003). Conclusion: Sympatho-vagal imbalance seems to be associated with sarcopenia in male patients with HF. These results highlight the importance of a therapeutic approach in patients with muscle wasting and increased peripheral sympathetic outflow. (AU)

• FAPESP's process: 16/24306-0 - The effect of NEPRIlysin (LCZ696) on EXercise TOLerance, muscle vasodilatation, muscle strength and body composition in patients with Heart Failure - NEPRIExTol-HF Trial
• Grantee: Marcelo Rodrigues dos Santos
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 15/22814-5 - Cancer and heart: new paradigms of diagnosis and treatment
• Grantee: Carlos Eduardo Negrão
• Support Opportunities: Research Projects - Thematic Grants