ABC | Volume 112, Nº6, June 2019

Original Article Fonseca et al Autonomic imbalance, sarcopenia and heart failure Arq Bras Cardiol. 2019; 112(6):739-746 Table 1 – Demographic and clinical characteristics of the study population Variables All patients (n = 116) Patients with sarcopenia (n = 33) Patients without sarcopenia (n = 83) P value Age (y) 55 ± 9 59 ± 6 54 ± 9 0.002 Weight (kg) 71.1 ± 14.4 59.4 ± 7.4 75.8 ± 13.8 < 0.001 Height (m) 1.67 ± 0.07 1.66 ± 0.07 1.67 ± 0.07 0.401 BMI (kg/m 2 ) 25.5 ± 4.5 21.6 ± 2.5 27.1 ± 4.2 < 0.001 Aetiology (Ischaemic/non-ischaemic) 30/86 8/25 22/61 1.000 NYHA class (I/II/III/IV) 40/41/28/7 9/11/11/2 31/30/17/5 0.500 LVEF (%) 28 ± 8 26 ± 7 29 ± 8 0.124 BNP (pg/mL) 773 ± 877 1159 ± 924 621 ± 816 0.006 Sodium (mEq/L) 139 ± 3 138 ± 4 139 ± 3 0.383 Potassium (mEq/L) 4.6 ± 0.4 4.6 ± 0.3 4.6 ± 0.4 0.535 Creatinine (mg/dL) 1.24 ± 0.39 1.27 ± 0.47 1.23 ± 0.35 0.568 Haemoglobin (g/dL) 13.9 ± 1.7 13.3 ± 1.6 14.1 ± 1.7 0.022 hs-CRP (mg/L) 8.96 ± 16.0 12.4 ± 13.6 7.6 ± 16.7 0.147 Triglyceride (mg/dL) 118 ± 68 96 ± 38 127 ± 75 0.031 Cholesterol (mg/dL) 170 ± 45 159 ± 37 174 ± 48 0.111 HDL (mg/dL) 44 ± 15 47 ± 16 44 ± 14 0.306 LDL (mg/dL) 103 ± 35 95 ± 25 106 ± 38 0.155 Fasting glucose (mg/dL) 108 ± 21 106 ± 24 109 ± 20 0.510 Medication β-blocker 33 (100) 78 (94) 0.319 Statins 18 (55) 49 (59) 0.682 ACEI/ARB 31 (94) 76 (92) 1.000 Diuretics 26 (79) 62 (75) 0.811 Anticoagulants 12 (36) 32 (39) 1.000 Hydralazine 6 (18) 18 (22) 0.802 Isosorbide 6 (18) 18 (22) 0.802 Spironolactone 24 (73) 58 (70) 0.824 Data are presented as mean ± SD or %. P value referred to Student’s t-test and Chi-square test for medication. ACEI, angiotensin converting enzyme inhibitors; ARB: angiotensin receptor blockers; BMI: body mass index; BNP: B-type natriuretic peptide; HDL: high-density lipoprotein; hs-CRP: high-sensitivity C-reactive protein; LDL: low-density lipoprotein; LVEF: left ventricular ejection fraction; NYHA: New York Heart Association. Spearman’s correlation showed a positive correlation between appendicular lean muscle mass and ∆HRR1 and ∆HRR2 (Figures 3A and 3B, respectively). In addition, we observed a negative correlation between appendicular lean muscle mass and MSNA (Figure 3C). Absolute VO 2peak , relative VO 2peak , and peak workload were significantly lower in patients with sarcopenia than those without. Sarcopenic patients also showed higher ventilatory equivalent for carbon dioxide (VE/VCO 2 ) slope and dead space to tidal volume (VD/VT peak ) than non-sarcopenic patients, whereas VE peak was lower in patients with sarcopenia than those without (Table 2). Body composition and muscle strength characteristics Body mass index was lower in sarcopenic patients when compared with non-sarcopenic, with a significant reduction in appendicular lean muscle mass, total lean mass, fat mass, and fat percentage (Table 2). SMI and muscle strength assessed by handgrip dynamometer were also lower in patients with sarcopenia compared with those without sarcopenia. Discussion The main and new findings of this study are that sarcopenic patients with HF have increased resting MSNA and blunted vagal reactivation after maximal exercise testing when compared with patients without sarcopenia. Moreover, the appendicular lean muscle mass seems to be associated with higher MSNA and blunted HRR. Additionally, as previously demonstrated, 2 we also confirmed the reduction in exercise tolerance (decreased peak VO 2 and peak workload) in patients with HF and muscle wasting. 741