Predicting Sarcopenia and Frailty Risk in Patients Post Heart Transplantation

ABSTRACT Introduction Currently, there is little evidence on the prevalence and factors associated with sarcopenia risk or frailty risk in patients post heart transplantation (HTx). The objective of this study was to analyze the influence of sociodemographic, lifestyle, physical, and psychological factors on sarcopenia and frailty risk in patients post‐HTx. Methods 133 patients post‐HTx (59.4% men, mean age 56.5 ± 12.7 years) participated in this cross‐sectional study. The main outcomes were sarcopenia and frailty risk, and potential related predictors were comorbidities, time from transplantation, body mass index, sociodemographic factors, musculoskeletal pain, functional capacity, kinesiophobia, sleep problems, depression, physical activity, and diet quality. Multiple regression models were performed with all predictors, including polynomial regressions for predictors with a nonlinear relationship. Results The predictor variables explained 73.93% of frailty's variance. Functional capacity (with a nonlinear relationship) and diet quality were significant predictors of frailty risk, while diabetes and physical activity were marginally significant. In addition, the predictors explained 73.52% of sarcopenia's variance. Diabetes, functional capacity (with a nonlinear relationship), and kinesiophobia were significant predictors of sarcopenia risk, while pain intensity and diet quality were marginally significant. Conclusion Multivariate analysis conducted on patients post‐HTx revealed that functional capacity was associated with both sarcopenia and frailty risk. Additionally, diet quality was a predictive factor of frailty, while diabetes and kinesiophobia were predictors of sarcopenia. These findings emphasize the importance of proper management to prevent frailty and sarcopenia, which share common associated factors.

Reply to “Expanding Perspectives on Sarcopenia and Frailty Risk in Heart Transplant Recipients”

Enduring a Major Marine Heatwave: The Role of Local Cool Refugia and Kelp Forests in the Resilience of Marine Invertebrates

ABSTRACT Aim Ecological “bright spots” remain resilient following climate events such as marine heatwaves. One explanation for resilience is that small‐scale variability in ocean temperature sustains cooler areas that emerge as local bright spots. In cases where foundational species like kelp thrive through marine heatwaves, the species that rely on kelp for habitat and food also benefit. Here, we test the effect of temperature and habitat loss across both space and time on marine invertebrate communities. Location The Channel Islands National Park in Southern California. Methods We use 25 years (1995–2019) of the National Park Service Kelp Forest Monitoring program surveys, focusing on permanent transects at 16 sites (including some within marine protected areas) that recorded the abundance of 30 kelp forest invertebrates, and include two major marine heatwave events (1997–1998 El Niño event and 2014–2016 combined “Blob” and El Niño event). We examine the effect of local in situ temperature and kelp cover on local diversity and drivers of abrupt diversity changes within the invertebrate communities. Results Sites with more kelp cover and lower local temperatures supported more even invertebrate communities. Additionally, we show evidence of a major state shift within the invertebrate communities during the “Blob” event where local ocean temperatures at surveyed sites better predicted the presence of species density shifts than kelp cover did. Cooler sites underwent more abrupt changes in invertebrate abundance, with these changes resulting in increases of warm‐affinity urchin species that prevented kelp recovery after the “Blob” resided. Main Conclusions We show that changes in kelp forest communities did not occur gradually, but through abrupt invertebrate abundance shifts even in protected areas. Contrary to expectations, we found some species benefitted from marine heatwaves, highlighting the importance of examining species‐specific responses in improving our understanding of how communities respond to environmental changes and marine heatwaves.

Motor, physical, and behavioural performance of 3‐ to 5‐year‐old children at risk of developmental coordination disorder: A longitudinal observational study

Abstract Aim To compare the motor, physical, and behavioural performance of children at risk of developmental coordination disorder (rDCD) and typically developing children at 3, 4, and 5 years of age. Method Following a longitudinal design, 35 mainly high‐risk children identified as rDCD by a multidisciplinary team at a centre for developmental disabilities and 34 typically developing children participated. Children were assessed with the Movement Assessment Battery for Children, Second Edition, Dutch/Belgian version (MABC‐2‐NL), Beery‐Buktenica Test of Visual‐Motor Integration (Beery VMI‐6), Little Developmental Coordination Disorder Questionnaire – Belgian version (LDCDQ‐BE), Motor Skill Checklist, Functional Strength Measurement, body mass index, and Child Behavior Checklist. Linear mixed‐model analyses compared performance between groups (rDCD and typically developing) and subgroups (confirmed and cleared DCD at 5 years). Results Children with rDCD scored significantly worse on all outcomes at every time point compared with typically developing children, except for visual perception. Performance on the MABC‐2‐NL, Beery VMI‐6 subtest motor coordination, and LDCDQ‐BE was also consistently below average for those in the rDCD group. Performance across time points was stable in the rDCD group, with only a significant improvement in LDCDQ‐BE. Children not diagnosed with DCD ( n  = 5) were mostly similar in performance to the typically developing group. Interpretation Performance differences are present at 3 years in high‐risk children at rDCD and tend to persist between 3 and 5 years.

Real‐world impact of tirzepatide on the risk of progression to type 2 diabetes and metabolic outcomes in people with obesity and pre‐diabetes

Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease—A practical update for clinicians

Abstract Albuminuria, the abnormal presence of albumin in urine, is a key marker of kidney damage and a strong predictor of kidney and cardiovascular outcomes. Its clinical significance has evolved from early historical observations to its current role in chronic kidney disease (CKD) detection, risk stratification and treatment monitoring. Advances in measurement techniques and evidence from large‐scale studies have reinforced its prognostic value, particularly in guiding interventions such as renin‐angiotensin‐aldosterone system blockade, sodium‐glucose cotransporter‐2 inhibitors and non‐steroidal mineralocorticoid receptor antagonists. Albuminuria assessment is now integrated into CKD staging, cardiovascular risk prediction models and therapy selection. Despite its established utility, challenges remain, including measurement variability, assay standardisation and under‐utilisation in clinical practice. This review provides a practical update on albuminuria testing, summarising its historical development, technical aspects and clinical implications, and emphasising its role in CKD management and cardiovascular risk assessment.

Methamphetamine‐Associated Pulmonary Arterial Hypertension Is Associated With Worse Right Ventricular Function Than Idiopathic Pulmonary Arterial Hypertension: A Matched Study

Abstract Background Methamphetamine is increasingly recognized as a cause of pulmonary arterial hypertension (PAH). This study examines whether non‐invasively measured metrics of right heart function, right atrial (RA) and right ventricular (RV) strain, are more impaired in methamphetamine‐associated PAH (MA‐PAH) compared with idiopathic PAH (IPAH). Methods A retrospective cohort analysis of 51 patients with MA‐PAH matched for mean pulmonary artery pressure (mPAP) with 51 patients with IPAH followed at the pulmonary hypertension clinic at the University of Utah was performed. Invasive hemodynamics and echocardiographic measures of right heart function, including RA strain and RV free wall strain, were compared. Results Compared to the matched IPAH group, MA‐PAH patients had lower cardiac index (2.04 ± 0.84 vs. 2.52 ± 1.07 L/min/m 2 , p = 0.016) and higher pulmonary vascular resistance (PVR; 11.8 ± 6.8 vs. 8.9 ± 4.8 Wood units, p = 0.018). The MA‐PAH group had larger RA maximal and minimal volume, lower RA reservoir strain (26.4 ± 11.7 vs. 33.4 ± 14.8 %, p = 0.011), more significant RV chamber dilation, and lower fractional area change (FAC; 21.1 ± 11.1 % vs. 34.5 ± 11.8 %, p < 0.001), compared to the IPAH group. RV e’ was lower in MA‐PAH (6.5 ± 2.8 cm/s vs. 8.3 ± 4.3 cm/s, p = 0.021), suggesting worse RV diastolic function and RV free wall strain was significantly more reduced compared to patients with I‐PAH (17.0 ± 6.5 vs. 22.3 ± 7.2 %, p < 0.001). There were no differences in 5‐year survival ( p = 0.26), 6MW distance including stratification for males and females ( p = 0.249 in females, p = 0.279 in males), and rehospitalization rates within 5 years of diagnosis ( p = 0.70). Discussion Despite a similar mPAP, patients with MA‐PAH had more RA dilation, RV dilation, lower RV systolic/diastolic function, and worse RA and RV mechanics as assessed by strain compared to patients with I‐PAH. Our findings suggest that, in addition to causing remodeling of the pulmonary vasculature, methamphetamine may have a direct cardiotoxic effect on the right heart.

Cover Image, Volume 42, Issue 5

The cover image is based on the article Methamphetamine‐Associated Pulmonary Arterial Hypertension Is Associated With Worse Right Ventricular Function Than Idiopathic Pulmonary Arterial Hypertension: A Matched Study by Emily ONeill, Katharine Clapham et al., https://doi.org/10.1111/echo.70180 .

Emerging horizons in predictive biogeography

ORPHEE : A Real‐World Study on rIX ‐ FP Prophylaxis Use in Adolescent/Adult Patients With Hemophilia B

ABSTRACT Objectives To assess the real‐world efficacy and safety of recombinant factor IX albumin fusion protein (rIX‐FP) in patients with hemophilia B (HB) in France. Methods Data on dosing frequency, weekly consumption, and bleeds before‐and‐after switching to rIX‐FP, were collected from December 2021 to February 2024. Annualized (spontaneous) bleeding rates [A(s)BRs] were calculated only in patients on prophylaxis with a follow‐up ≥ 6 months. Results This interim analysis focused on 77 patients ≥ 12 years; 62 (81%) had severe HB. After switching to rIX‐FP, the infusion interval was 14 (7–14) days. Weekly consumption was 43 (35.5–53) IU/kg. ABRs and AsBRs were 0.5 (0–1.9) and 0 (0–0.7) ( n  = 63) at 18.2 (12.3–21.9) months of follow‐up. Prophylactic efficacy of rIX‐FP was considered ‘Excellent’/‘Good’ in 65/68 (95%) patients. Among the 43 patients previously treated with rFIXFc, 21 increased the infusion interval from 7 (7–11) days with rFIXFc to 14 (7–14) days with rIX‐FP; 33/43 (77%) reduced weekly factor IX (FIX) consumption from 59.95 (46.35–77.93) to 42.5 (35.88–50.25) IU/kg. Patients maintained good protection against bleeds. Conclusion This analysis confirmed that switching to rIX‐FP allows for reducing injection frequency and FIX consumption while maintaining good bleed protection.