Serum myostatin levels in chronic heart failure.

Muscle wasting is common in advanced heart failure. Myostatin is an important modulator of muscle catabolism. We measured serum levels of myostatin and its propeptide in patients with chronic heart failure and analyzed their relationships with clinical parameters and prognosis. The study included 70 patients: 30 in New York Heart Association (NYHA) functional class I-II and 40 in class III-IV. Their mean ejection fraction was 32%+/-12%. The mean follow-up time was 17.9+/-1.3 months. Thirteen patients (18.6%) died. No correlation was found between myostatin and myostatin propeptide levels. Nor was the myostatin or myostatin propeptide level correlated with age, sex, left ventricular ejection fraction, symptom duration, or the level of N-terminal probrain natriuretic peptide (NT-proBNP) or tumor necrosis factor-alpha receptor type-2 (TNFalpha R2). Moreover, no relationship was observed between the myostatin or myostatin propeptide level and NYHA functional class or mortality, in contrast to the relationships found with NT-proBNP (P< .001 and P< .001, respectively) and TNFalpha R2 (P=.001 and P=.005, respectively) levels. In conclusion, there was no relationship between the myostatin or myostatin propeptide level and any parameter of disease severity or prognosis in patients with chronic heart failure.

Niveles séricos de miostatina en insuficiencia cardiaca crónica / Serum myostatin levels in chronic heart failure

La afección muscular es frecuente en la insuficiencia cardiaca avanzada. La miostatina es un importante modulador del catabolismo muscular. Analizamos la concentración sérica de miostatina y su propéptido en pacientes con insuficiencia cardiaca crónica y su relación con parámetros clínicos y el pronóstico. Se incluyó a 70 pacientes en clase funcional I-II (30) y III-IV (40) de la NYHA, con una media de fracción de eyección del 32% ± 12%. El seguimiento medio fue 17,9 ± 1,3 meses. Fallecieron 13 pacientes (18,6%). No encontramos correlación entre la concentración de miostatina y la de su propéptido. Tampoco entre éstos y edad, sexo, fracción de eyección, duración de los síntomas, concentraciones de NT-proBNP y de r2-TNFα. Ni miostatina ni su propéptido se relacionaron con la clase funcional ni con la mortalidad, a diferencia de NT-proBNP (p < 0,001 y p < 0,001) y r2-TNFα (p = 0,001 y p = 0,005). Las concentraciones de miostatina y su propéptido no se relacionaron con parámetros de severidad ni con el pronóstico en pacientes con insuficiencia cardiaca crónica (AU)

Muscle wasting is common in advanced heart failure. Myostatin is an important modulator of muscle catabolism. We measured serum levels of myostatin and its propeptide in patients with chronic heart failure and analyzed their relationships with clinical parameters and prognosis. The study included 70 patients: 30 in New York Heart Association (NYHA) functional class I-II and 40 in class III-IV. Their mean ejection fraction was 32%±12%. The mean follow-up time was 17.9±1.3 months. Thirteen patients (18.6%) died. No correlation was found between myostatin and myostatin propeptide levels, nor was the myostatin or myostatin propeptide level correlated with age, sex, left ventricular ejection fraction, symptom duration, or the level of N-terminal probrain natriuretic peptide (NT-proBNP) or tumor necrosis factor-alpha receptor type-2 (TNFα R2). Moreover, no relationship was observed between the myostatin or myostatin propeptide level and NYHA functional class or mortality, in contrast to the relationships found with NT-proBNP (P < .001 and P < .001, respectively) and TNFα R2 (P=.001 and P=.005, respectively) levels. In conclusion, there was no relationship between the myostatin or myostatin propeptide level and any parameter of disease severity or prognosis in patients with chronic heart failure (AU)

Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure.

INTRODUCTION AND OBJECTIVES: Heart failure patients have high levels of frailty and dependence. Our aim was to determine the impact of frailty and depressive symptoms on the 1-year mortality rate and the rate of hospitalization for heart failure during a follow-up period of 1 year. METHODS: All patients underwent geriatric evaluation, and frailty and depressive symptoms were identified. The study included 622 patients (72.5% male; median age, 68 years; 92% in New York Heart Association class II or III; and median ejection fraction, 30%). RESULTS: During follow-up, 60 patients (9.5%) died and 101 (16.2%) were hospitalized for heart failure. Overall, 39.9% of patients exhibited frailty, while 25.2% had depressive symptoms. There were significant associations between mortality at 1 year and the presence of frailty (16.9% vs. 4.8%; P< .001) and depressive symptoms (15.3% vs. 7.7%; P=.006). There was also a significant relationship between heart failure hospitalization and the presence of frailty (20.5% vs. 13.3%; P=.01). No relationship was found between heart failure hospitalization and depressive symptoms. Frailty was an independent predictor of mortality but not of hospitalization. CONCLUSIONS: Univariate analysis demonstrated significant relationships between frailty and depressive symptoms and mortality at 1 year. In addition, there was a significant relationship between frailty and the need for heart failure hospitalization. However, only frailty showed prognostic value to predict mortality, which was independent of other variables strongly associated to outcome.

Implicación pronóstica de la fragilidad y los síntomas depresivos en una población ambulatoria con insuficiencia cardiaca / Prognostic Implication of Frailty and Depressive Symptoms in an Outpatient Population With Heart Failure

Introducción y objetivos. Los pacientes con insuficienciacardiaca presentan un elevado grado de fragilidady dependencia. Durante 1 año de seguimiento, examinamosla relación de la fragilidad y los síntomas depresivoscon la mortalidad a 1 año y con la hospitalización por insuficiencia cardiaca.Métodos. Todos los pacientes fueron sometidos a unavaloración geriátrica que permitiría la detección de fragilidad y de síntomas depresivos. Se evaluó a 622 pacientes (el 72,5% varones; mediana de edad, 68 años; el 92% se hallaba en clase II o III de la NYHA; la mediana de fracción de eyección era del 30%).Resultados. Fallecieron durante el seguimiento 60(9,5%) pacientes, y 101 (16,2%) tuvieron que ser hospitalizados por insuficiencia cardiaca. Se detectó fragilidad en el 39,9% de los pacientes y síntomas depresivos en el 25,2%. La fragilidad (el 16,9 frente al 4,8%; p < 0,001) y los síntomas depresivos (el 15,3 frente al 7,7%; p = 0,006) resultaron estar relacionados con la mortalidad a 1 año de forma significativa. También se detectó una relación significativa entre la fragilidad y la hospitalización por insuficiencia cardiaca (el 20,5 frente al 13,3%; p = 0,01).No se observó relación entre síntomas depresivos y hospitalización por insuficiencia cardiaca. La fragilidad resultó tener un valor predictivo independiente de mortalidad pero no de hospitalización.Conclusiones. En el análisis univariable, la fragilidad ylos síntomas depresivos mostraron una relación significativa con la mortalidad a 1 año; además, la fragilidad mostró una relación significativa con la necesidad de hospitalización por insuficiencia cardiaca. Sin embargo, sólo la fragilidad mostró un valor predictivo de mortalidad independiente de otras variables con fuerte influencia en el pronóstico

Introduction and objectives. Heart failure patientshave high levels of frailty and dependence. Our aim wasto determine the impact of frailty and depressivesymptoms on the 1-year mortality rate and the rate ofhospitalization for heart failure during a follow-up period of 1 year.Methods. All patients underwent geriatric evaluation,and frailty and depressive symptoms were identified. Thestudy included 622 patients (72.5% male; median age, 68years; 92% in New York Heart Association class II or III;and median ejection fraction, 30%).Results. During follow-up, 60 patients (9.5%) died and101 (16.2%) were hospitalized for heart failure. Overall,39.9% of patients exhibited frailty, while 25.2% haddepressive symptoms. There were significantassociations between mortality at 1 year and thepresence of frailty (16.9% vs. 4.8%; P<.001) anddepressive symptoms (15.3% vs. 7.7%; P=.006). Therewas also a significant relationship between heart failurehospitalization and the presence of frailty (20.5% vs.13.3%; P=.01). No relationship was found between heartfailure hospitalization and depressive symptoms. Frailtywas an independent predictor of mortality but not ofhospitalization.Conclusions. Univariate analysis demonstrated significant relationships between frailty and depressivesymptoms and mortality at 1 year. In addition, there was a significant relationship between frailty and the need for heart failure hospitalization. However, only frailty showed prognostic value to predict mortality, which wasindependent of other variables strongly associated tooutcome

[Prognostic significance of creatinine clearance rate in patients with heart failure and normal serum creatinine]. / Significado pronóstico del aclaramiento de creatinina en pacientes con insuficiencia cardiaca y creatinina sérica normal.

Kidney failure is an important prognostic factor in patients with heart failure. Renal function is usually evaluated by measuring the serum creatinine level. However, a normal creatinine level can mask established kidney failure. We investigated the prognostic significance of the estimated creatinine clearance rate (Cockcroft formula) in 235 patients with heart failure and a normal serum creatinine level. The two-year mortality rate was significantly higher in patients who had established kidney disease (i.e., a creatinine clearance rate <60 mL/min) than in those who did not (35.1% vs. 10.1%, P<.001). Even when only patients without established kidney failure were analyzed, the creatinine clearance rate had prognostic significance (rate > or = 90 mL/min, mortality 3.2%; rate 89-60 mL/min, mortality 13.9%; P=.02). On Cox regression analysis, which included age, sex, heart failure etiology, left ventricular ejection fraction, diabetes and hypertension, the creatinine clearance rate remained an independent predictor of mortality.

Significado pronóstico del aclaramiento de creatinina en pacientes con insuficiencia cardiaca y creatinina sérica normal / Prognostic significance of creatinine clearance rate in patients with heart failure and normal serum creatinine

La insuficiencia renal es un importante factor pronóstico en pacientes con insuficiencia cardiaca. Para valorar la función renal se suelen utilizar las cifras de creatinina sérica. Sin embargo, cifras normales pueden ocultar una insuficiencia renal establecida. Hemos evaluado el significado pronóstico del aclaramiento de creatinina estimado (Cockcroft) en 235 pacientes con insuficiencia cardiaca y cifras de creatinina normales. Los pacientes con insuficiencia renal establecida (aclaramiento < 60 ml/min) tuvieron una mortalidad a 2 años muy superior a la de aquellos sin ella (el 35,1 y el 10,1%; p < 0,001). Incluso al analizar exclusivamente a los pacientes sin insuficiencia renal establecida, el aclaramiento de creatinina demostró tener significación pronóstica (≥ 90 ml/min, mortalidad del 3,2%; 89-60 ml/min, mortalidad del 13,9%; p = 0,02). En el análisis de regresión de Cox en el que se incluyeron además edad, sexo, etiología de la insuficiencia cardiaca, clase funcional, fracción de eyección de ventrículo izquierdo, diabetes e hipertensión, el aclaramiento de creatinina permaneció como predictor independiente de mortalidad (AU)

Kidney failure is an important prognostic factor in patients with heart failure. Renal function is usually evaluated by measuring the serum creatinine level. However, a normal creatinine level can mask established kidney failure. We investigated the prognostic significance of the estimated creatinine clearance rate (Cockcroft formula) in 235 patients with heart failure and a normal serum creatinine level. The two-year mortality rate was significantly higher in patients who had established kidney disease (i.e., a creatinine clearance rate <60 mL/min) than in those who did not (35.1% vs. 10.1%, P<.001). Even when only patients without established kidney failure were analyzed, the creatinine clearance rate had prognostic significance (rate ≥ 90 mL/min, mortality 3.2%; rate 89­60 mL/min, mortality 13.9%; P=.02). On Cox regression analysis, which included age, sex, heart failure etiology, left ventricular ejection fraction, diabetes and hypertension, the creatinine clearance rate remained an independent predictor of mortality (AU)

[Does body mass index influence mortality in patients with heart failure?]. / El índice de masa corporal influye en la mortalidad de los pacientes con insuficiencia cardiaca?

INTRODUCTION AND OBJECTIVES: Obesity is an independent risk factor for congestive heart failure. Paradoxically, improved survival has been observed in obese heart failure patients. The objective of this study was to analyze the relationship between body mass index (BMI) and the 2-year mortality rate in outpatients with heart failure of different etiologies who were attending a heart failure unit. METHODS: Baseline BMI and survival status at 2-year follow-up were recorded in 501 patients (73% men, median age 68 years). Heart failure etiology was mainly ischemic heart disease, present in 59%. The patients' median ejection fraction was 30%. They were divided into four groups according to BMI: low weight (<20.5), normal weight (20.5 to <25.5), overweight (25.5 to <30), and obese (>/=30). RESULTS: The mortality rate at 2 years differed significantly (P< .001) between the groups: 46.7% for low-weight patients, 27.8% for normal-weight patients, 18.7% for overweight patients, and 16% for obese patients. After adjusting for age, sex, heart failure etiology, functional class, ejection fraction, hypertension, diabetes, estimated creatinine clearance rate, plasma hemoglobin level, and treatment received, BMI remained an independent predictor of reduced mortality at 2 years (odds ratio=0.92 [0.88-0.97]). CONCLUSIONS: A high BMI has been associated with lower all-cause mortality rates at 2-year follow-up. Our findings in a broad population of patients with heart failure of different etiologies further confirm the existence of a paradoxical relationship between obesity and heart failure outcome.

¿El índice de masa corporal influye en la mortalidad de los pacientes con insuficiencia cardiaca? / Does body mass index influence mortality in patients with heart failure?

Introducción y objetivos. La obesidad es un factor de riesgo independiente de que se desarrolle insuficiencia cardiaca. Paradójicamente, se ha observado una mayor supervivencia en los pacientes obesos con insuficiencia cardiaca. El objetivo del estudio es analizar la relación entre el índice de masa corporal (IMC) y la mortalidad a 2 años en una población ambulatoria de pacientes con insuficiencia cardiaca de diferentes etiologías en una unidad especializada. Métodos. Se analizó el índice de masa corporal en la primera visita y la supervivencia a 2 años en 501 pacientes (el 73% varones; mediana de edad, 68 años). La principal etiología de la insuficiencia cardiaca fue la cardiopatía isquémica (59%). La fracción de eyección media fue del 30%. Los pacientes fueron clasificados en función de su índice de masa corporal en 4 grupos: bajo peso (IMC < 20,5), peso normal (IMC de 20,5 a < 25,5), sobrepeso (IMC de 25,5 a < 30) y obesidad (IMC ≥ 30). Resultados. La mortalidad a 2 años difirió significativamente (p < 0,001) entre los distintos grupos: bajo peso, 46,7%; peso normal, 27,8%; sobrepeso, 18,7%, y obesidad, 16%. Tras ajustar por edad, sexo, etiología, clase funcional, fracción de eyección, hipertensión, diabetes, aclaramiento de creatinina estimado, hemoglobina plasmática y los tratamientos realizados, el IMC permaneció como predictor independiente de mortalidad a 2 años (odds ratio = 0,92 [0,88-0,97]). Conclusiones. Un mayor IMC tiene relación con menor mortalidad por todas las causas a los 2 años de seguimiento. Nuestros resultados contribuyen a confirmar, en una población general con insuficiencia cardiaca de diferentes etiologías, la relación paradójica entre la obesidad y el pronóstico de la insuficiencia cardiaca (AU)

Introduction and objectives. Obesity is an independent risk factor for congestive heart failure. Paradoxically, improved survival has been observed in obese heart failure patients. The objective of this study was to analyze the relationship between body mass index (BMI) and the 2-year mortality rate in outpatients with heart failure of different etiologies who were attending a heart failure unit. Methods. Baseline BMI and survival status at 2-year follow-up were recorded in 501 patients (73% men, median age 68 years). Heart failure etiology was mainly ischemic heart disease, present in 59%. The patients' median ejection fraction was 30%. They were divided into four groups according to BMI: low weight (<20.5), normal weight (20.5 to <25.5), overweight (25.5 to <30), and obese (≥30). Results. The mortality rate at 2 years differed significantly (P<.001) between the groups: 46.7% for low-weight patients, 27.8% for normal-weight patients, 18.7% for overweight patients, and 16% for obese patients. After adjusting for age, sex, heart failure etiology, functional class, ejection fraction, hypertension, diabetes, estimated creatinine clearance rate, plasma hemoglobin level, and treatment received, BMI remained an independent predictor of reduced mortality at 2 years (odds ratio=0.92 [0.88-0.97]). Conclusions. A high BMI has been associated with lower all-cause mortality rates at 2-year follow-up. Our findings in a broad population of patients with heart failure of different etiologies further confirm the existence of a paradoxical relationship between obesity and heart failure outcome (AU)

[Clinical, echocardiographic and prognostic evaluation of atrial fibrillation in patients with heart failure]. / Valoración clínica, ecocardiográfica y pronóstica de la fibrilación auricular en pacientes con insuficiencia cardíaca.

BACKGROUND AND OBJECTIVE: We aimed to assess the prevalence of atrial fibrillation (AF) in a general heart failure (HF) population admitted to a HF unit, analyze the parameters associated with AF, and evaluate its prognostic significance. PATIENTS AND METHOD: 389 patients, 64 with AF at the first visit. Mean (SD) age was 65.38 (10.77) years and 72.5% were men. The main etiology was ischemic heart disease (59.9%). Mean ejection fraction (EF) was 32.25% (13%). Vital status at 2 years was available in 377 patients (97%), 314 in sinus rhythm (SR) and 63 in AF. RESULTS: The prevalence of AF was 15.8%. AF was associated with: older age, female gender, valvular and hypertensive etiology, longer time since the onset of HF symptoms, higher EF, higher left atrium diameter, degree of mitral regurgitation, and lower quality of life, but not with the NYHA functional class. The 2-years mortality (16.7%) was significantly higher in patients with AF (33.3% vs 18.4%; OR = 2.20; 95% confidence interval, 1.21-4). However, when adjusted for other relevant variables such as age, NYHA functional class, ejection fraction, sex and etiology, AF did not remain as an independent prognostic factor. The strongest mortality differences between patients with AF and those with SR where observed in ischemic heart disease and dilated cardiomyopathy. CONCLUSIONS: AF was associated mainly with age, valvular and hypertensive etiology, higher left atrium diameter and lower end-systolic left ventricular diameter. Two years mortality was significantly higher in patients with AF, although other parameters such as age and NYHA functional class had a higher prognostic value.

Valoración clínica, ecocardiográfica y pronóstica de la fibrilación auricular en pacientes con insuficiencia cardíaca / Clinical, echocardiographic and prognostic evaluation of atrial fibrillation in patients with heart failure

Fundamento y objetivo: Valorar la prevalencia de fibrilación auricular (FA) en pacientes con insuficiencia cardíaca de una unidad multidisciplinaria, analizar los factores asociados y evaluar su significación pronóstica. Pacientes y método: Se incluyó a 389 pacientes, 64 con FA en la primera visita. La media (desviación estándar) de la edad fue 65,38 (10,77) años; el 72,5% eran varones. La etiología era isquémica en el 59,9%. La fracción de eyección (FE) media era de 32,25% (13%). A los 2 años conocíamos la situación vital de 377 (97%) pacientes (314 en ritmo sinusal [RS] y 63 en FA). Resultados: La prevalencia de FA era del 15,8% y se asociaba con mayor edad, sexo femenino, etiologías hipertensiva y valvular, mayor duración de los síntomas, mejor FE, mayor diámetro de la aurícula izquierda, mayor grado de insuficiencia mitral y peor calidad de vida, pero no con la clase funcional de la New York Heart Association (NYHA). La mortalidad a los 2 años (16,7%) era significativamente mayor en los pacientes con FA (el 33,3 frente al 18,4%; odds ratio = 2,20; intervalo de confianza del 95%, 1,21-4), aunque al ajustar por otras variables relevantes como la edad, el sexo, la clase funcional, la FE y la etiología, la FA no se mantuvo como factor pronóstico independiente. Las diferencias más importantes de mortalidad ocurrían en la insuficiencia cardíaca de causa isquémica y por miocardiopatía dilatada. Conclusiones: La FA tuvo relación, fundamentalmente, con la edad, la etiología valvular e hipertensiva y un mayor diámetro de la aurícula izquierda. La mortalidad a los 2 años era significativamente mayor en los pacientes con FA, aunque otros parámetros como la edad y la clase funcional de la NYHA tenían mayor significación pronóstica

Background and objective: We aimed to assess the prevalence of atrial fibrillation (AF) in a general heart failure (HF) population admitted to a HF unit, analyze the parameters associated with AF, and evaluate its prognostic significance. Patients and method: 389 patients, 64 with AF at the first visit. Mean (SD) age was 65.38 (10.77) years and 72.5% were men. The main etiology was ischemic heart disease (59.9%). Mean ejection fraction (EF) was 32.25% (13%). Vital status at 2 years was available in 377 patients (97%), 314 in sinus rhythm (SR) and 63 in AF. Results: The prevalence of AF was 15.8%. AF was associated with: older age, female gender, valvular and hypertensive etiology, longer time since the onset of HF symptoms, higher EF, higher left atrium diameter, degree of mitral regurgitation, and lower quality of life, but not with the NYHA functional class. The 2-years mortality (16.7%) was significantly higher in patients with AF (33.3% vs 18.4%; OR = 2.20; 95% confidence interval, 1.21-4). However, when adjusted for other relevant variables such as age, NYHA functional class, ejection fraction, sex and etiology, AF did not remain as an independent prognostic factor. The strongest mortality differences between patients with AF and those with SR where observed in ischemic heart disease and dilated cardiomyopathy. Conclusions: AF was associated mainly with age, valvular and hypertensive etiology, higher left atrium diameter and lower end-systolic left ventricular diameter. Two years mortality was significantly higher in patients with AF, although other parameters such as age and NYHA functional class had a higher prognostic value