Locomotor and respiratory muscle abnormalities in HFrEF and HFpEF

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  Figure 1. Wasting continuum in heart failure. Both HFrEF and HFpEF leads to loss of muscle quality and quantity followed by loss of fat and bone tissue in a substantial proportion of HF patients. Definitions of sarcopenia and cachexia may differ between countries and societies leading to some uncertainties in the prevalence of those conditions. Clinically, sarcopenia is associated with frailty leading into disability and increased mortality with cachexia. Prevalence for sarcopenia in HFrEF and HFpEF from Bekfani et al. (13), cachexia in HFrEF from von Haehling et al. (14), and cachexia in HFpEF from Pocock et al. (15). Definitions of sarcopenia according to the consensus definitions by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) in 2018 (16) and the Sarcopenia Definition and Outcomes Consortium (SDOC) in 2020 (17). Definition of cachexia according to Evans et al. (18). ASM indicates appendicular skeletal muscle; BIA, bioelectrical impedance analysis; CT, computed tomography; DEXA, dual-energy x-ray absorptiometry; F, female; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; M, male; MRI, magnetic resonance…

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  Figure 2. Structural and molecular changes in locomotor and respiratory muscles in HFrEF and HFpEF. Those changes contribute to impaired muscle mass and function in both entities contributing to a worse outcome. HFrEF indicates heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; IGF-1, insulin-like growth factor 1; MuRF1, muscle ring finger protein 1; ROS, reactive oxygen species.

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  Figure 3. Effects of exercise training on heart failure associated myopathy. Primary effects of different forms of exercise training on locomotor and/or respiratory muscle changes in heart failure associated myopathy. Evidence suggests that a combination of all three modalities provides superior outcome with regard to surrogate endpoints in HF patients with the need for larger studies to confirm this finding (214).