Expression And Clinical Significance Of AMPK/SIRT1 In Elderly Patients With Chronic Heart Failure Complicated With Sarcopenia

Objective Chronic heart failure and myopenia have common pathogenesis.It has been found that serum levels of silence information regulator 1（SIRTI）and adenosine mono-phosphate-activated protein kinase（AMPK）are associated with the pathogenesis of chronic heart failure and myopenia.Therefore,through this study,we further investigated the expression of AMPK and SIRTI in serum of patients with chronic heart failure and myopenia,and analyzed the correlation between AMPK and SIRTI and N-terminal B-type natriuretic peptide（NT-proBNP）,grip strength and limb skeletal muscle index.Methods This study included elderly patients with chronic heart failure with myopenia,elderly patients with chronic heart failure without myopenia and elderly patients without chronic heart failure without myopenia who visited Hangzhou third people’s hospital from September 2019 to June 2021.According to the criteria of muscular dystrophy in the expert consensus of the Asian Muscular Dystrophy working Group and the diagnostic criteria of Chinese guidelines for the diagnosis and treatment of chronic heart failure,patients were divided into three groups:chronic heart failure with myopenia group,chronic heart failure without myopenia group and non-chronic heart failure non-myopenia group.the clinical data of the three groups were recorded in detail,including the demographic data,serum AMPK and SIRT1,cardiac function,6 minutes walking distance,grip strength and limb skeletal muscle index were statistically analyzed.Results A total of 95 patients were finally included in this study,among which the chronic heart failure with sarcopenia group had the characteristics of decreased SIRT1 and AMPK-αcompared with the chronic heart failure without sarcopenia group（P<0.05）.Compared with patients with non-chronic heart failure and non-sarcopenia,the patients with sarcopenia also had the characteristics of decreased SIRT1 and AMPK-α（P<0.05）.In terms of cardiac function,compared with the patients in the chronic heart failure without sarcopenia group,patients with chronic heart failure combined with sarcopenia had increased NT-proBNP,and significantly decreased LVEF,LVFS and 6 minutes walking distance（P<0.05）.Compared with the non-chronic heart failure and non-sarcopenia group,patients with chronic heart failure without sarcopenia also had the characteristics of increased NT-proBNP,and significantly decreased LVEF,LVFS and 6 minutes walking distance（P<0.05）.In terms of limb skeletal muscle content and muscle strength,the grip strength and limb skeletal muscle index of patients with chronic heart failure combined with sarcopenia were significantly lower than those of patients with chronic heart failure without sarcopenia（P<0.05）.SIRT1 and AMPK-α were negatively correlated with NT-proBNP（r=0.7203 and 0.7553,P<0.0001）,SIRT1 and AMPK-α were positively correlated with grip strength（r= 0.5291 and 0.5946,P<0.0001）,AMPK-α was positively correlated with AMSI（r=0.3399,P=0.0008）,and SIRT1 was positively correlated with AMPK-α（r=0.8196,P<0.0001）.The areas under the ROC curve of AMPK-α and SIRT1 are 0.9331 and 0.8319.Conclusion First,the serum levels of SIRT1 and AMPK-α are lower in patients with chronic heart failure with myopenia than those without myopenia.Second,patients with chronic heart failure with myopenia had higher NT-proBNP,lower LVEF,LVFS and shorter 6 minutes walking distance than those without myopenia.Third,SIRT1 and AMPK-α were negatively correlated with NT-proBNP and positively correlated with grip strength.There was a positive correlation between AMPK-α and AMSI,and between AMPK-α and SIRT1.Fourth,serum SIRT1 and AMPK-α may become biomarkers for diagnosing chronic heart failure with myopenia and evaluating the severity of the disease,which provides new ideasand new targets for the diagnosis and intervention of chronic heart failure patients with myopenia.