Advertisement
Heart, Lung and Circulation

Association Between Serum Myostatin Levels, Hospital Mortality, and Muscle Mass and Strength Following ST-Elevation Myocardial Infarction

Published:September 28, 2021DOI:https://doi.org/10.1016/j.hlc.2021.08.018

      Aim

      This study aimed to evaluate the association between serum myostatin levels, hospital mortality, and muscle mass and strength following ST-segment elevation myocardial infarction (STEMI).

      Methods

      This was a prospective observational study. Within 48 hours of admission, bioelectrical impedance and handgrip strength were assessed and blood samples collected for myostatin evaluation. Hospital mortality was recorded. A multiple logistic regression model was also constructed, adjusted by parameters that exhibited significant differences in the univariate analysis, to evaluate the association between myostatin levels and hospital mortality.

      Results

      One hundred and two (102) patients were included: mean age was 60.5±10.6 years, 67.6% were male, and 6.9% died during hospital stay. Univariate analysis showed that patients with lower myostatin levels had higher mortality rates. Serum myostatin levels positively correlated with handgrip strength (r=0.355; p<0.001) and appendicular skeletal muscle mass index (r=0.268; p=0.007). Receiver operating characteristic (ROC) curve analysis revealed that lower myostatin levels were associated with hospital mortality at the <2.20 ng/mL cut-off. Multiple logistic regression showed that higher serum myostatin levels were associated with reduced hospital mortality when adjusted by β blocker use (OR, 0.228; 95% CI, 0.054–0.974; p=0.046).

      Conclusions

      Serum myostatin concentrations positively correlated with muscle mass and strength in STEMI patients. Further assessment of serum myostatin association with mortality should be conducted using a larger sample and assessing the additive value to the Global Registry of Acute Coronary Events (GRACE) or thrombolysis in myocardial infarction (TIMI) risk scores.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Levine G.N.
        • Bates E.R.
        • Blankenship J.C.
        • Bailey S.R.
        • Bittl J.A.
        • Cercek B.
        • et al.
        2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction.
        J Am Coll Cardiol. 2016; 67: 1235-1250
        • Ibanez B.
        • James S.
        • Agewall S.
        • Antunes M.J.
        • Bucciarelli-Ducci C.
        • Bueno H.
        • et al.
        2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39: 119-177
        • Townsend N.
        • Wilson L.
        • Bhatnagar P.
        • Wickramasinghe K.
        • Rayner M.
        • Nichols M.
        • et al.
        Cardiovascular disease in Europe: epidemiological update 2016.
        Eur Heart J. 2016; 37: 3232-3245
        • Pedersen F.
        • Butrymovich V.
        • Kelbaek H.
        • Wachtell K.
        • Helqvist S.
        • Kastrup J.
        • et al.
        Short- and long-term cause of death in patients treated with primary PCI for STEMI.
        J Am Coll Cardiol. 2014; 64: 2101-2108
        • Salvagno G.L.
        • Pavan C.
        Prognostic biomarkers in acute coronary syndrome.
        Ann Transl Med. 2016; 4: 258
        • Lim S.
        • McMahon C.D.
        • Matthews K.G.
        • Devlin G.P.
        • Elston M.S.
        • Conaglen J.V.
        Absence of myostatin improves cardiac function following myocardial infarction.
        Heart Lung Circ. 2018; 27: 693-701
        • Shyu K.G.
        • Lu M.J.
        • Wang B.W.
        • Sun H.Y.
        • Chang H.
        Myostatin expression in ventricular myocardium in a rat model of volume-overload heart failure.
        Eur J Clin Invest. 2006; 36: 713-719
        • Lima A.R.R.
        • Martinez P.F.
        • Okoshi K.
        • Guizoni D.M.
        • Zornoff L.A.M.
        • Campos D.H.S.
        • et al.
        Myostatin and follistatin expression in skeletal muscle of rats with chronic heart failure.
        Int J Exp Path. 2010; 91: 54-62
        • Castillero E.
        • Akashi H.
        • Wang C.
        • Najjar M.
        • Ji R.
        • Kennel P.J.
        • et al.
        Cardiac myostatin upregulation occurs immediately after myocardial ischemia and is involved in skeletal muscle activation of atrophy.
        Biochem Biophys Res Commun. 2015; 457: 106-111
        • Arrieta H.
        • Hervas G.
        • Rezola-Pardo C.
        • Ruiz-Litago F.
        • Iturburu M.
        • Yanguas J.J.
        • et al.
        Serum myostatin levels are higher in fitter, more active, and non-frail long-term nursing home residents and increase after a physical exercise intervention.
        Gerontology. 2019; 65: 229-239
        • Bergen 3rd, H.R.
        • Farr J.N.
        • Vanderboom P.M.
        • Atkinson E.J.
        • White T.A.
        • Singh R.J.
        • et al.
        Myostatin as a mediator of sarcopenia versus homeostatic regulator of muscle mass: insights using a new mass spectrometry-based assay.
        Skelet Muscle. 2015; 5: 21
        • Meloux A.
        • Rochette L.
        • Maza M.
        • Bichat F.
        • Tribouillard L.
        • Cottin Y.
        • et al.
        Growth differentiation factor-8 (GDF8)/myostatin is a predictor of troponin peak and a marker of clinical severity after acute myocardial infarction.
        J Clin Med. 2020; 9: 116
        • American Diabetes Association
        2. Classification and Diagnosis of Diabetes.
        Diabetes Care. 2016; 39: S13-S22
        • James P.A.
        • Oparil S.
        • Carter B.L.
        • Cushman W.C.
        • Dennison-Himmelfarb C.
        • Handler J.
        • et al.
        2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
        JAMA. 2014; 311: 507-520
        • Gumieiro D.N.
        • Murino Rafacho B.P.
        • Buzati Pereira B.L.
        • Cavallari K.A.
        • Tanni S.E.
        • Azevedo P.S.
        • et al.
        Vitamin D serum levels are associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture.
        Nutrition. 2015; 31: 931-934
        • Gumieiro D.N.
        • Rafacho B.P.
        • Gradella L.M.
        • Azevedo P.S.
        • Gaspardo D.
        • Zornoff L.A.M.
        • et al.
        Handgrip strength predicts pressure ulcers in patients with hip fractures.
        Nutrition. 2012; 28: 874-878
        • Polegato B.F.
        • Herrera M.A.
        • Pereira B.L.B.
        • Silva R.A.C.
        • Gonçalves A.F.
        • Cavallari K.A.
        • et al.
        Phase angle is associated with the length of ICU stay in patients with non-ST elevation acute coronary syndrome.
        Nutrire. 2017; 42: 2
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • Afilalo J.
        • Armstrong A.
        • Ernande L.
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28: 1-39
        • Cogni A.L.
        • Farah E.
        • Minicucci M.F.
        • Azevedo P.S.
        • Okoshi K.
        • Matsubara B.B.
        • et al.
        Metalloproteinases-2 and -9 predict left ventricular remodeling after myocardial infarction.
        Arq Bras Cardiol. 2013; 100: 315-321
        • Cogni A.L.
        • Farah E.
        • Minicucci M.F.
        • Azevedo P.S.
        • Okoshi K.
        • Matsubara B.B.
        • et al.
        Waist circumference, but not body mass index, is a predictor of ventricular remodeling after anterior myocardial infarction.
        Nutrition. 2013; 29: 122-126
        • McPherron A.C.
        • Lawler A.M.
        • Lee S.J.
        Regulation of skeletal muscle mass in mice by a new TGF-beta superfamily member.
        Nature. 1997; 387: 83-90
        • White T.A.
        • LeBrasseur N.K.
        Myostatin and sarcopenia: opportunities and challenges – a mini-review.
        Gerontology. 2014; 60: 289-293
        • Sharma M.
        • Kambadur R.
        • Matthews K.G.
        • Somers W.G.
        • Devlin G.P.
        • Conaglen J.V.
        • et al.
        Myostatin, a transforming growth factor-beta superfamily member, is expressed in heart muscle and is upregulated in cardiomyocytes after infarct.
        J Cell Physiol. 1999; 180: 1-9
        • Lenk K.
        • Schur R.
        • Linke A.
        • Erbs S.
        • Matsumoto Y.
        • Adams V.
        • et al.
        Impact of exercise training on myostatin expression in the myocardium and skeletal muscle in a chronic heart failure model.
        Eur J Heart Fail. 2009; 11: 342-348
        • Sartori R.
        • Romanello V.
        • Sandri M.
        Mechanisms of muscle atrophy and hypertrophy: implications in health and disease.
        Nat Commun. 2021; 12: 330
        • Sartori R.
        • Milan G.
        • Patron M.
        • Mammucari C.
        • Blaauw B.
        • Abraham R.
        • et al.
        Smad2 and 3 transcription factors control muscle mass in adulthood.
        Am J Physiol Cell Physiol. 2009; 296: C1248-C1257
        • Ju C.R.
        • Chen R.C.
        Serum myostatin levels and skeletal muscle wasting in chronic obstructive pulmonary disease.
        Respir Med. 2012; 106: 102-108
        • Gruson D.
        • Ahn S.A.
        • Ketelslegers J.M.
        • Rousseau M.F.
        Increased plasma myostatin in heart failure.
        Eur J Heart Fail. 2011; 13: 734-736
        • Furihata T.
        • Kinugawa S.
        • Fukushima A.
        • Takada S.
        • Homma T.
        • Masaki Y.
        • et al.
        Serum myostatin levels are independently associated with skeletal muscle wasting in patients with heart failure.
        Int J Cardiol. 2016; 220: 483-487