The primary goal of this study is to improve our understanding of changes in skeletal muscle mass in the arms and the legs during a hospitalization for advanced HF. We plan to measure muscle thickness with an ultrasound machine in two locations on the body (the outer thigh and the upper arm muscle, of the dominant side) from the time a patient is first admitted to the ICU with HF as well as before and after any surgical HF therapies. We anticipate that patients lose some muscle mass during a period of bed rest while they are critically unwell, but we do not currently know how much muscle mass loss is normal or abnormal. An additional purpose of this study is to better understand the relationship between muscle mass, muscle strength and nutritional health in patients requiring the ICU. We will also learn how changes in muscle thickness during hospitalization relate to outcomes such as length of hospital stay and recovery after HF treatments, including discharge to home versus a rehabilitation center. Longer term, our goal is for muscle ultrasound to become a part of the nutritional assessment of patients with HF to better guide clinicians in making treatment choices that improve health and recovery.
Changes in Skeletal Muscle Thickness in Patients with Acute Heart Failure
18-100
Overview
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Study details
- - Over 18 years of age
- - Ejection fraction <40%
- - Cardiogenic shock defined by clinical criteria (including any of: lactate >2.5 mmol/L, systolic blood pressure <90 mmHg, acute kidney or liver injury, or cardiac index <2.1 on hemodynamic monitoring) plus the clinical requirement for at least one pressor, inotrope, or temporary mechanical circulatory support device (MCSD)
- - Prior history of LVAD or other durable ventricular assist device
- - An identified clinical disorder associated with skeletal muscle weakness/wasting (e.g., muscular dystrophy, mitochondrial disorder, active cancer, modified Rankin score 4 post-stroke)
- - Chronic enteric and parenteral nutrition support patients
The study will use ultrasound imaging to assess changes in skeletal muscle thickness in two body locations. Ultrasound pictures will be taken on the lateral (outer) thigh and at the bicep (upper arm muscle) at each of the ultrasound time-points. We will use a BodyMetrix Pro A-mode ultrasound device (made by BodyMetrix Pro, Intelametrix Inc., Livermore, CA) which is a lay imaging tool designed specifically to assess body composition. Images will be taken at intervals during the hospital stay on the dominant side if able to identify, or else on the right side (unless lines or devices prevent access to the preferred side). On each occasion we will take five images at each body location, with the best images being used for analysis. Participants in this study will be measured 2-3 days after first admitted to the ICU, then 3 days, 7 days, then weekly thereafter from the first measurement. Each measurement session will last approximately 20-30 minutes. This process will be performed by the Principal Investigator or trained registered dietitians (RDs). This ultrasound procedure is for this research study only and is not part of standard ICU care.