Association between fetuin A in sarcopenic cardiomyopathy among an elderly cohort echocardiographic survey

Abstract

Background: Sarcopenia, an aging condition interpreting the generalized muscle mass wasting, may be associated with several degenerating processes. With increasing incidence of heart failure among elders, the association between sacropenic status and the aging process in the heart function will be crucial. Fetuin A (FetA), a calcification inhibitor as well as a conjunction in insulin resistance, has been recently observed as a factor for body composition remodeling. We hypothesized that FetA plays a pathophysiologic role in Sarcopenic Heart Failure (SHF) via the diastolic or systolic dysfunction process. Patients and methods: Totally 541 elders were enrolled in an elderly cohort echocardiographic survey in 2012. The sarcopenia was defined by EWGSOP 2010 criteria. We recorded their medical history, measured serologic markers, including eGFR, insulin resistance (HbA1c, HOMA), hsCRP, and FetA. Cardiac echocardiographic parameters, such as Left Ventricular Ejection Fraction (LVEF), diastolic function (E/A) and estimated end-diastolic pressure (E/E') were also obtained. Subjects were defined as Sarcopenia Heart Failure (SHF) once both criteria of sarcopenia and systolic dysfunction were fulfilled. Results: There were totally 89 (16.4%) patients (80.2(plus or minus)5.9 years of age, male: 30.3%) diagnosed as sarcopenia in this geriatric cohort, among them, 22 (24.7%) were fulfilled as SHF. Compared to control group without evidence of sarcopenia, those sarcopenic subjects showed reduced systolic heart function (LVEF: 68.4(plus or minus)8.6% vs. 64.2(plus or minus)9.3%, p=0.007), higher end diastolic pressure (E/E' 7.5(plus or minus)2.1 vs. 10.3(plus or minus)4.4, p=0.001) and higher FetA level (621.1(plus or minus)140.7 vs. 697.3(plus or minus)179 (mu)g/ml, p=0.0001). Further subgroup analysis revealed significantly high FetA level in SHF compared those sarcopenia with preserved LVEF (664.3(plus or minus)163.8 vs. 788.2(plus or minus)170.2 (mu)g/ml, p=0.0001). Among non-sarcopenic group, FetA was not different between preserved or impaired LVEF (620.5(plus or minus)142.2, 604.9(plus or minus)104.3 (mu)g/ml, p>0.05). Multivariable logistic regression showed that existing of coronary artery disease, reduced waist circumference, higher E/E' value and higher FetA level showed independent and significant association to predict SHF, which also indicated the possible mechanism via FetA in the diastolic relaxation maladaptation to the sarcopneic aging process. Conclusion: In this elderly cohort association study, we found that FetA was significantly higher in sarcopenic elders, especially when their heart diastolic and systolic functions were impaired. These data imply the possible link between FetA and the sarcopenic heart.