Detection of muscle wasting in patients with chronic heart failure using C-terminal agrin fragment: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF).

AIMS Skeletal muscle wasting affects 20% of patients with chronic heart failure and has serious implications for their activities of daily living. Assessment of muscle wasting is technically challenging. C-terminal agrin-fragment (CAF), a breakdown product of the synaptically located protein agrin, has shown early promise as biomarker of muscle wasting. We sought to investigate the diagnostic properties of CAF in muscle wasting among patients with heart failure. METHODS AND RESULTS We assessed serum CAF levels in 196 patients who participated in the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Muscle wasting was identified using dual-energy X-ray absorptiometry (DEXA) in 38 patients (19.4%). Patients with muscle wasting demonstrated higher CAF values than those without (125.1 ± 59.5 pmol/L vs. 103.8 ± 42.9 pmol/L, P = 0.01). Using receiver operating characteristics (ROC), we calculated the optimal CAF value to identify patients with muscle wasting as >87.5 pmol/L, which had a sensitivity of 78.9% and a specificity of 43.7%. The area under the ROC curve was 0.63 (95% confidence interval 0.56-0.70). Using simple regression, we found that serum CAF was associated with handgrip (R = - 0.17, P = 0.03) and quadriceps strength (R = - 0.31, P < 0.0001), peak oxygen consumption (R = - 0.5, P < 0.0001), 6-min walk distance (R = - 0.32, P < 0.0001), and gait speed (R = - 0.2, P = 0.001), as well as with parameters of kidney and liver function, iron metabolism and storage. CONCLUSION CAF shows good sensitivity for the detection of skeletal muscle wasting in patients with heart failure. Its assessment may be useful to identify patients who should undergo additional testing, such as detailed body composition analysis. As no other biomarker is currently available, further investigation is warranted.

La música /

A poem.

La oda a la música de Fray Luis de León /

With: La existencia como economía y como caridad / Antonio Caso. -- México : Porrúa Hermanos, 1916.

Cuento de amor; fantasía cómica en un acto y en verso y prosa por Justo S. López de Gomara, música del eminente maestro d. Juan Goula ...

Without music.

La música que pasa.

Poems.

Música suave, versos /

At head of title: José de J. Núñez y Domínquez.

El día la noche. Opera cómica en cuatro actos de Alberto Vanloo y Enrique Leterrier. Música de Carlos Lecocq.

Without music.

Sobre un trozo de música Griega /

Reprint from Anales de la universidad.

O planalto meridional do Brasil : estudos sobre a estructura física, geología, clima, raças, recursos naturaes, evolução econômica e futuro da região /

Mode of access: Internet.

Novísimo diccionario geográfico, histórico, pintoresco universal ; descripcion física, histórica, política, comercial, estadística, industrial, científica, literaria, artística, religiosa, moral, etc. de todas las partes del mundo ...

Mode of access: Internet.

Reseña histórica del Conservatorio nacional de música y declamacion, 1849 á 1911.

"Album, 1911," portrait groups; [23] p. at end.

Manual de educación física para las escuelas elementales de Puerto Rico.

"Preparada por el señor Frank Campos."--p. 5.

Teorías modernas de la física : unidad de las fuerzas materiales /

Mode of access: Internet.

Sica tragica comiti Mauritio a Iesuitis : vt aiunt Caluinistae Leydae intentata /

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