Circulation, Volume 150, Issue Suppl_1, Page A4136678-A4136678, November 12, 2024. Background:Evaluation of sarcopenia requires quantifying appendicular skeletal muscle mass and functional capacity, but resource constraints often limit feasibility. Alterations in muscle quality, especially intramuscular lipid infiltration (i.e., myosteatosis), and systemic metabolic derangements are associated with disability.Hypothesis:Opportunistic CT imaging and plasma amino acid profiling could identify low physical function in patients with heart failure (HF).Methods:We retrospectively examined 220 HF patients (74 ± 13 years old; 59% male) who underwent plasma amino acid profiling, abdominal CT imaging, and dual-energy X-ray absorptiometry (DXA) scan within two months. Myosteatosis was evaluated using single-slice CT imaging at the L3/4 level and quantified as mean muscle attenuation (MMA). Physical function was assessed by the short physical performance battery (SPPB), with low physical function defined as SPPB ≤9.Results:CT-derived single-slice areas of skeletal muscle and adipose tissue were highly correlated with DXA-derived appendicular skeletal muscle mass and total fat mass. Logistic regression analyses revealed that higher age and lower MMA, but not skeletal muscle area, were significantly associated with low physical function independently of NT-proBNP. Subjects with MMA below the median value (32.0 HU for males and 23.7 HU for females) had higher odds of low physical function (adjusted OR 2.04, 95% CI 1.04-3.96). Ten amino acids and the Fischer ratio were significantly correlated with MMA levels. Multivariate regression analyses, adjusted for potential confounders including age, gender, and body mass index, demonstrated that serum albumin and Fischer ratio were independent determinants of MMA levels. When serum albumin and Fischer ratio were dichotomized by their median values (3.6 mg/dL and 3.23, respectively), the prevalence of low physical function was significantly higher in subjects with low albumin and low Fischer ratio, but not in those with low levels of only either parameter, compared to those with high albumin and high Fischer ratio (adjusted OR 2.36, 95% CI 1.02-5.49).Conclusions:Myosteatosis assessed by single-slice abdominal CT imaging is an independent determinant of low physical function in HF patients. Combined with an assessment of serum albumin and Fischer ratio, these simple biomarkers could facilitate the early detection of patients at risk for developing frailty.
Search Results for: Dalla presbifagia alla sarcopenia, il trattamento in medicina generale
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Abstract 4119926: Inadequate calorie and macronutrient intake in a population with congestive heart failure in a non-cardiovascular tertiary hospital.
Circulation, Volume 150, Issue Suppl_1, Page A4119926-A4119926, November 12, 2024. Introduction:Chronic Heart Failure (HF) is a clinical syndrome that as a consequence of the compensatory mechanisms to maintain an adequate level of perfusion, causes dyspnea, peripheral edema, fatigue, lack of appetite, changes in body weight, cachexia, sarcopenia, among others. The presence of these signs and symptoms, with other factors such as restrictions on salt and water consumption, early satiety, and poor mobility, producing changes in the patient’s nutritional status that can indirectly increase the risk of inadequate dietary intake, which over a prolonged period will lead to the development of nutritional deficiencies.Objective:To analyze the dietary intake of energy, macronutrients, and micronutrients of patients with chronic HF in outpatient care.Methods:Cross-sectional study, including 75 outpatients with HF, who attended a Heart Failure Clinic. Data collection on dietary intake was obtained using a multi-step 24-hour recall. The ESHA Food Processor program was used to calculate the energy, macronutrient, and micronutrient intake. The presence of congestion was evaluated by bioelectrical impedance vectorial analysis and VEXUS.Results:The baseline characteristics of the population are shown in Table 1. Of the total population, 34% presented with deficient caloric intake, and the subjects who presented congestion also ingested significant fewer calories compared with those who do not present congestion (p= 0.031). Only 15% of patients had an adequate protein intake that resulted in lower NYHA class; among those subjects with a deficient protein intake, 72% had congestion measured by VExUS or bioelectrical impedance. For the sodium intake in the subjects’ diet, 45% exceeded the recommendation stated in the guidelines of less than 2,400 mg of sodium per day which was not statistically significant (p=0.077).Discussion and Conclusions:The inadequate intake of calorie or macronutrients in patients with CHF led the patients to more congestion and higher NYHA class, this provide a perspective on the importance of adequate nutritional advice by an expert in the area, which is also essential to improve the clinical course of heart failure. Likewise, future studies are deeded to investigate whether this poor dietary intake is inversely related to some clinical manifestations such as congestion, suggesting that improving these conditions could positively impact patients’ volume status and improve functional class.
Abstract 4146141: The Association of Geriatric Syndromes with Cardiovascular Disease: Insights from ARIC Visit 5 on Cardiovascular Risks in Older Adults
Circulation, Volume 150, Issue Suppl_1, Page A4146141-A4146141, November 12, 2024. Introduction:Older adults face a high burden of cardiovascular disease (CVD), exacerbated by geriatric conditions such as multimorbidity and polypharmacy. The collective influence on CVD risk remains unclear. We hypothesize that the coexistence of multiple geriatric syndromes increases the risk of incident CVD events .Methods:We conducted a cross-sectional study among individuals aged 45–64 years using a logistic regression to assess the association between geriatric syndrome(had ≥3factors) and CVD events at the end of Visit 5(period prevalence) in the Atherosclerosis Risk in Communities(ARIC study). We examined the following geriatric conditions: multimorbidity (≥2 chronic conditions), polypharmacy (≥5 medications), cognitive impairment vision impairment, hearing impairment, urinary incontinence, functional decline, frailty, and sarcopenia. Primary outcome was prevalence of 3-point MACE, defined as: death, acute myocardial infarction (AMI), or stroke.Results:Among the 5,141 participants, 13% had no geriatric conditions, 18% had one, 17% had two, and 52% had ≥3. Participants with ≥3 geriatric conditions were generally older, female, White, and overweight with hospitalization rates of 3. Overall,18% of the cohort experienced MACE events and 82% didn’t, with death being the most common at 9%. Those with ≥3 geriatric conditions had the highest prevalence of stroke (5%), AMI (11%), and death (13%) as compared to 2,1 and 0 geriatric conditions which were 2%,6%,7% and 1%,3%,6% and 1%,2%,3% respectively. In the adjusted model, having ≥3 geriatric conditions was associated with significantly higher odds of AMI (OR = 6.47; 95% CI: 3.57-13.18), stroke (OR=6.33; 95% CI: 2.83-18.08), death (OR = 3.51; 95% CI: 2.20-5.95), and MACE (OR=4.92; 95% CI: 3.44-7.28) compared with having no conditionConclusion:We found a strong association between the number of prevalent geriatric conditions and increased cardiovascular risk in the older adults. This highlights the need for integrated care models to identify geriatric conditions in older adults with cardiovascular disease in order to tailor prevention and treatment.
Abstract Su1007: Temporal muscle thickness correlates with premorbid clinical frailty in patients resuscitated from cardiac arrest
Circulation, Volume 150, Issue Suppl_1, Page ASu1007-ASu1007, November 12, 2024. Introduction:Previous work has associated frailty with mortality and neurologic outcomes in patients resuscitated from cardiac arrest. The Clinical Frailty Scale (CFS) – a 9-point ordinal scale with higher values indicating a higher degree of frailty – is the most used measure in critically ill patients, however there is no established gold-standard. Temporal muscle thickness (TMT) is a measure of sarcopenia, which represents a specific physical frailty phenotype.Aim:We assessed the correlation between TMT, measured on head computed tomography (CT), and the CFS in patients resuscitated from cardiac arrest.Hypothesis:TMT negatively correlates with pre-arrest CFS.Methods:We enrolled adult patients who were resuscitated from cardiac arrest and had a head CT obtained within 48 hours of collapse at our regional academic facility. Patient characteristics were recorded in our prospective registry. Study investigators prospectively obtained pre-arrest CFS through a patient or surrogate interview. Blinded study investigators reviewed head CTs and measured TMT bilaterally at 5mm above the superior orbital rim, adjacent to the Sylvian fissure. We then averaged the two measurements within each patient. We summarized patient demographics and arrest characteristics with descriptive statistics. We calculated Spearman rank-order correlation to assess the relationship between average TMT and CFS.Results:Of 20 included subjects, mean age was 57 (SD 13), 6 (30%) were female, 17 (85%) were out-of-hospital arrests, 6 (32%) had an initial shockable rhythm, and median Charlson Comorbidity Index was 2 (IQR 0-3). Mean TMT in our cohort was 6.7 millimeters (SD 2.6) and median CFS was 3 (IQR 2-6). There was a negative, moderate correlation between average TMT and CFS; r(18) = -0.50,p= 0.02.Conclusions:We found that TMT exhibits a moderate negative correlation with the CFS, providing face validity that TMT may be a tool to measure frailty. Measuring TMT in patients with early head CTs after resuscitation from cardiac arrest may allow for characterization of pre-arrest frailty.
Assessment of muscle strength in elderly as a screening method for sarcopenia in primary care: a scoping review
Objectives
To identify and map the available evidence for whether a test of handgrip strength (HGS) and/or the chair stand test (CST) have been used as screening tools for the detection of sarcopenia in elderly individuals within primary care settings.
Design
This study was designed as a scoping review, in accordance with the methodological framework for scoping reviews, developed by Arksey and O’Malley, and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews.
Data sources
A literature search was conducted to identify relevant articles listed in PubMed and Scopus databases up to 16 October 2023.
Eligibility criteria
Studies including individuals aged ≥60 years who had undergone assessments of HGS and/or the CST in primary care settings were included.
Data extraction and synthesis
Following the article selection process, based on predetermined criteria for inclusion and exclusion, the selected articles were analysed regarding population demographics, the setting in which the research was conducted, the study design, used diagnostic tools and reported results.
Results
The search yielded 282 unique articles, of which 7 were included in the final analysis. All seven included articles had a cross-sectional study design, whereof one also had a longitudinal 3-year follow-up. The number of participants ranged from 75 to 719. Three of the articles used the diagnostic criteria presented by European Working Group on Sarcopenia in Older People (EWGSOP), two used the criteria by Asian Working Group for Sarcopenia 2019, one used the EWGSOP2 criteria and one applied both the EWGSOP and EWGSOP2 criteria to their data. All the articles used HGS to assess muscle strength. CST was not used for this purpose in any of the articles, although it was used to estimate physical performance or as part of the short physical performance battery. The prevalence of sarcopenia in the included articles was 12.0%–20.7%, while the prevalence of possible sarcopenia was 69.9%–73.3% and that of probable sarcopenia was 25.5%–94%.
Conclusion
None of the included articles aimed to study a test of HGS and/or the CST as screening tools for the detection of sarcopenia. However, four of the articles diagnosed possible or probable sarcopenia by using a test of HGS and/or the CST among elderly patients in a primary care setting. There is a need for more research to elucidate whether a test of HGS and/or the CST might be used for screening of sarcopenia in primary care.
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