Abstract
Chronic heart failure (CHF) is a disease with important clinical and socio-economic ramifications. Malnutrition and severe alteration of the protein components of the body (protein disarrangements), common conditions in CHF patients, are independent correlates of heart dysfunction, disease progression, and mortality. Autophagy, a prominent occurrence in the heart of patients with advanced CHF, is a self-digestive process that prolongs myocardial cell lifespan by the removal of cytosolic components, such as aging organelles and proteins, and recycles the constituent elements for new protein synthesis. However, in specific conditions, excessive activation of autophagy can lead to the destruction of molecules and organelles essential to cell survival, ultimately leading to organ failure and patient death. In this review, we aim to describe the experimental and clinical evidence supporting a pathophysiological role of nutrition and autophagy in the progression of CHF. The understanding of the mechanisms underlying the interplay between nutrition and autophagy may have important clinical implications by providing molecular targets for innovative therapeutic strategies in CHF patients.
Highlights
Serum albumin deficiency is observed in about 30% of Chronic heart failure (CHF) patients [18], with or without concurrent anemia [10]
The impact of hypoalbuminemia on survival is not limited to heart failure with reduced ejection fraction as albumin levels were predictive of mortality in patients with heart failure with preserved ejection fraction [18]
It has been recently demonstrated that CHF patients have lower concentrations of amino acids (AAs), essential AAs (EAAs), with an inverse relationship to heart failure severity [23]
Summary
Chronic diseases (CDs) are characterized by chronic inflammation with accompanying increased catabolism and reduced anabolism. According to the World Health Organization, malnutrition is a condition defined as a supply/demand imbalance at the cellular level between the nutrients/energy intake and the organism’s real demand for nutrients essential to ensure its correct development and maintenance [11] This inadequate caloric and nutrient intake can lead to a decrease in muscle mass and immune system function with consequent deterioration in the quality of life, as demonstrated by a correlation between malnutrition and survival [12,13]. In a study of 1673 patients hospitalized with acute heart failure (either reduced or preserved ejection fraction), the prognostic nutritional index was independently associated with cardiovascular mortality and all-cause mortality [32]. In heart failure patients in the outpatient setting, malnutrition assessed using the Mini Nutritional Assessment screening tool was predictive of mortality [37] and was an independent predictor of all-cause mortality or heart failure-related hospitalizations in outpatients with heart failure with mid-range ejection fraction [38]
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