{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T02:45:54Z","timestamp":1788576354703,"version":"build-2803163510"},"reference-count":105,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Sarcopenia is increasingly recognized as a key extracardiac manifestation of heart failure (HF), contributing to functional impairment, reduced quality of life, and adverse clinical outcomes. Characterized by progressive loss of skeletal muscle mass, strength, and physical performance, it affects more than half of hospitalized HF patients. It is independently associated with increased mortality and reduced exercise capacity. The pathophysiology of sarcopenia in HF is multifactorial and closely linked to metabolic and nutritional disturbances. Chronic inflammation, neurohormonal activation, oxidative stress, endothelial dysfunction, and anabolic resistance contribute to muscle catabolism and impaired protein synthesis. These alterations are further exacerbated by inadequate dietary protein intake and micronutrient deficiencies, promoting progressive muscle wasting and functional decline. Sarcopenia may also represent an early and potentially modifiable stage in the continuum toward cardiac cachexia. This narrative review provides a comprehensive synthesis of current evidence on the epidemiology, pathophysiological mechanisms, and management of sarcopenia in HF, with particular emphasis on nutritional and metabolic determinants. Emerging data support a multimodal therapeutic approach integrating exercise training with targeted nutritional strategies, including adequate protein intake, essential amino acid supplementation, and correction of micronutrient deficiencies. However, evidence from large, well-designed trials remains limited. In summary, improved recognition and integrated management of sarcopenia in HF are essential. Future research should focus on the development of effective, nutrition-centered therapeutic strategies.<\/jats:p>","DOI":"10.3390\/nu18091431","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:20:25Z","timestamp":1777551625000},"page":"1431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sarcopenia in Chronic Heart Failure: Pathophysiology, Clinical Consequences, and Emerging Multimodal Therapeutic Strategies"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3234-150X","authenticated-orcid":false,"given":"Dominik","family":"Kurczy\u0144ski","sequence":"first","affiliation":[{"name":"II Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Marii Sk\u0142odowskiej-Curie 10, 41-800 Zabrze, Poland"},{"name":"Doctoral School, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Za\u0142uczkowski","sequence":"additional","affiliation":[{"name":"School of Medicine, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Kalota","sequence":"additional","affiliation":[{"name":"School of Medicine, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brygida","family":"Przywara-Chowaniec","sequence":"additional","affiliation":[{"name":"II Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Marii Sk\u0142odowskiej-Curie 10, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9312-762X","authenticated-orcid":false,"given":"Andrzej","family":"Tomasik","sequence":"additional","affiliation":[{"name":"II Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Marii Sk\u0142odowskiej-Curie 10, 41-800 Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.jacc.2003.07.046","article-title":"Heart Failure with Preserved Left Ventricular Systolic Function: Epidemiology, Clinical Characteristics, and Prognosis","volume":"43","author":"Hogg","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/0735-1097(92)90167-L","article-title":"The Neurohormonal Hypothesis: A Theory to Explain the Mechanism of Disease Progression in Heart Failure","volume":"20","author":"Packer","year":"1992","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","first-page":"16135","article-title":"Sarcopenia and Cachexia in Chronic Diseases: From Mechanisms to Treatment","volume":"131","author":"Lena","year":"2021","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European Consensus on Definition and Diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"155533","DOI":"10.1016\/j.metabol.2023.155533","article-title":"Epidemiology of Sarcopenia: Prevalence, Risk Factors, and Consequences","volume":"144","author":"Yuan","year":"2023","journal-title":"Metabolism"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1002\/ehf2.13255","article-title":"Sarcopenia in Heart Failure: A Systematic Review and Meta-Analysis","volume":"8","author":"Zhang","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1159\/000496460","article-title":"Low Skeletal Muscle Mass Independently Predicts Mortality in Patients with Chronic Heart Failure after an Acute Hospitalization","volume":"142","author":"Lopez","year":"2019","journal-title":"Cardiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/jcsm.12603","article-title":"Muscle Wasting as an Independent Predictor of Survival in Patients with Chronic Heart Failure","volume":"11","author":"Valentova","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1093\/gerona\/glv129","article-title":"The Predictive Value of the EWGSOP Definition of Sarcopenia: Results from the InCHIANTI Study","volume":"71","author":"Bianchi","year":"2016","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"afae052","DOI":"10.1093\/ageing\/afae052","article-title":"The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS)","volume":"53","author":"Kirk","year":"2024","journal-title":"Age Ageing"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1093\/eurheartj\/ehs381","article-title":"Muscle wasting in patients with chronic heart failure (SICA-HF)","volume":"34","author":"Tacke","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1002\/ejhf.1304","article-title":"Comparison of Sarcopenia and Cachexia in Men with Chronic Heart Failure: Results from the Studies Investigating Co-Morbidities Aggravating Heart Failure (SICA-HF)","volume":"20","author":"Emami","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ehae666.843","DOI":"10.1093\/eurheartj\/ehae666.843","article-title":"Heart Failure\u2014Chronic Heart Failure, Pathophysiology and Mechanisms, Heart Failure with Reduced Ejection Fraction (HFrEF)","volume":"45","author":"Jensen","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"de Jorge-Huerta, L., Marco-Alacid, C., Grande, C., and Velardo Andr\u00e9s, C. (2024). A Narrative Review of the Diagnosis and Treatment of Sarcopenia and Malnutrition in Patients with Heart Failure. Nutrients, 16.","DOI":"10.3390\/nu16162717"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1113\/expphysiol.2013.074310","article-title":"Pathophysiology of Human Heart Failure: Importance of Skeletal Muscle Myopathy and Reflexes","volume":"99","author":"Piepoli","year":"2014","journal-title":"Exp. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"A22","DOI":"10.1016\/0002-9149(85)90792-1","article-title":"Cardiopulmonary exercise testing for evaluation of chronic heart failure","volume":"55","author":"Weber","year":"1985","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1093\/eurheartj\/ehs221","article-title":"Clinical recommendations for cardiopulmonary exercise testing data assessment in heart failure","volume":"33","author":"Guazzi","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1017\/S0029665115002438","article-title":"The Wasting Continuum in Heart Failure: From Sarcopenia to Cachexia","volume":"74","year":"2015","journal-title":"Proc. Nutr. Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.hfc.2019.08.006","article-title":"Cardiac Cachexia Revisited: The Role of Wasting in Heart Failure","volume":"16","author":"Valentova","year":"2020","journal-title":"Heart Fail. Clin."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S0140-6736(96)07015-8","article-title":"Wasting as an Independent Risk Factor for Mortality in Chronic Heart Failure","volume":"349","author":"Anker","year":"1997","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1007\/s11897-012-0090-z","article-title":"Skeletal Muscle Abnormalities in Chronic Heart Failure","volume":"9","author":"Georgiadou","year":"2012","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1161\/01.CIR.85.5.1751","article-title":"Alterations of Skeletal Muscle in Chronic Heart Failure","volume":"85","author":"Drexler","year":"1992","journal-title":"Circulation"},{"key":"ref_24","first-page":"3656","article-title":"Sarcopenia, Cachexia and Congestive Heart Failure in the Elderly","volume":"19","author":"Zamboni","year":"2013","journal-title":"Curr. Pharm. Des."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S0167-5273(02)00535-1","article-title":"Studies on Apoptosis and Fibrosis in Skeletal Musculature: A Comparison of Heart Failure Patients with and without Cardiac Cachexia","volume":"90","author":"Filippatos","year":"2003","journal-title":"Int. J. Cardiol."},{"key":"ref_26","first-page":"296","article-title":"Age-Related Cardiac Muscle Sarcopenia: Combining Experimental and Mathematical Modeling to Identify Mechanisms","volume":"43","author":"Lin","year":"2008","journal-title":"Biophys. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1093\/eurjpc\/zwab020","article-title":"Multiple Hormonal and Metabolic Deficiency Syndrome Predicts Outcome in Heart Failure: The T.O.S.CA. Registry","volume":"28","author":"Cittadini","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/S0735-1097(02)01736-9","article-title":"Reduction of Insulin-Like Growth Factor-I Expression in the Skeletal Muscle of Noncachectic Patients with Chronic Heart Failure","volume":"39","author":"Hambrecht","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S0735-1097(98)00226-5","article-title":"Deficient Insulin-Like Growth Factor I in Chronic Heart Failure Predicts Altered Body Composition, Anabolic Deficiency, Cytokine and Neurohormonal Activation","volume":"32","author":"Niebauer","year":"1998","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1161\/CIRCULATIONAHA.106.649426","article-title":"Anabolic Deficiency in Men with Chronic Heart Failure: Prevalence and Detrimental Impact on Survival","volume":"114","author":"Jankowska","year":"2006","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s13539-014-0152-z","article-title":"Skeletal Myopathy in Patients with Chronic Heart Failure: Significance of Anabolic-Androgenic Hormones","volume":"5","author":"Josiak","year":"2014","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_32","first-page":"739","article-title":"Sympatho-Vagal Imbalance Is Associated with Sarcopenia in Male Patients with Heart Failure","volume":"112","author":"Takayama","year":"2019","journal-title":"Arq. Bras. De Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/eurjhf\/hfr024","article-title":"Increased Plasma Myostatin in Heart Failure","volume":"13","author":"Gruson","year":"2011","journal-title":"Eur. J. Heart Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1161\/CIRCULATIONAHA.109.882068","article-title":"Genetic Deletion of Myostatin from the Heart Prevents Skeletal Muscle Atrophy in Heart Failure","volume":"121","author":"Heineke","year":"2010","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"H1973","DOI":"10.1152\/ajpheart.00200.2011","article-title":"Myostatin from the Heart: Local and Systemic Actions in Cardiac Failure and Muscle Wasting","volume":"300","author":"Breitbart","year":"2011","journal-title":"Am. J. Physiol.\u2014Heart Circ. Physiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1161\/CIRCRESAHA.116.308030","article-title":"Chronic Heart Failure and Inflammation","volume":"119","author":"Dick","year":"2016","journal-title":"Circ. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1093\/gerona\/glp097","article-title":"Higher Inflammatory Marker Levels in Older Persons: Associations with 5-Year Change in Muscle Mass and Muscle Strength","volume":"64","author":"Schaap","year":"2009","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2716","DOI":"10.1161\/CIRCULATIONAHA.111.047381","article-title":"Heart Failure Exercise Training Attenuates MuRF-1 Expression in the Skeletal Muscle of Patients with Chronic Heart Failure Independent of Age: The Randomized Leipzig Exercise Intervention in Chronic Heart Failure and Aging Catabolism Study","volume":"125","author":"Gielen","year":"2012","journal-title":"Circulation"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.exger.2003.09.012","article-title":"The Contribution of Reactive Oxygen Species to Sarcopenia and Muscle Ageing","volume":"39","author":"Fulle","year":"2004","journal-title":"Exp. Gerontol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1002\/ejhf.1320","article-title":"Treating Oxidative Stress in Heart Failure: Past, Present and Future","volume":"21","author":"Voors","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lian, D., Chen, M.-M., Wu, H., Deng, S., and Hu, X. (2022). The Role of Oxidative Stress in Skeletal Muscle Myogenesis and Muscle Disease. Antioxidants, 11.","DOI":"10.3390\/antiox11040755"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0002-9440(10)63335-4","article-title":"Glutathione Depletion Impairs Myogenic Differentiation of Murine Skeletal Muscle C2C12 Cells through Sustained NF-\u03baB Activation","volume":"165","author":"Ardite","year":"2004","journal-title":"Am. J. Pathol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jnutbio.2017.08.008","article-title":"Dietary resveratrol confers apoptotic resistance to oxidative stress in myoblasts","volume":"50","author":"Haramizu","year":"2017","journal-title":"J. Nutr. Biochem."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Zhou, T., Prather, E.R., Garrison, D.E., and Zuo, L. (2018). Interplay between ROS and Antioxidants during Ischemia-Reperfusion Injuries in Cardiac and Skeletal Muscle. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19020417"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1002\/jcp.10016","article-title":"Oxygen-mediated regulation of skeletal muscle satellite cell proliferation and adipogenesis in culture","volume":"189","author":"Csete","year":"2001","journal-title":"J. Cell. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Alem, M.M. (2019). Endothelial Dysfunction in Chronic Heart Failure: Assessment, Findings, Significance, and Potential Therapeutic Targets. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20133198"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ijcard.2016.02.139","article-title":"Impaired Skeletal Muscle Vasodilation during Exercise in Heart Failure with Preserved Ejection Fraction","volume":"211","author":"Lee","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"H3699","DOI":"10.1152\/ajpheart.00694.2007","article-title":"Increased Metaboreflex Activity Is Related to Exercise Intolerance in Heart Transplant Patients","volume":"293","author":"Houssiere","year":"2007","journal-title":"Am. J. Physiol.\u2014Heart Circ. Physiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.jchf.2018.02.018","article-title":"Prevalence and Prognostic Significance of Malnutrition Using 3 Scoring Systems among Outpatients with Heart Failure: A Comparison with Body Mass Index","volume":"6","author":"Sze","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"860","DOI":"10.7326\/0003-4819-121-11-199412010-00006","article-title":"Increased Resting Metabolic Rate in Patients with Congestive Heart Failure","volume":"121","author":"Poehlman","year":"1994","journal-title":"Ann. Intern. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s12603-018-1119-0","article-title":"Anorexia Is Independently Associated with Decreased Muscle Mass and Strength in Community-Dwelling Older Adults","volume":"23","author":"Bahat","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_52","first-page":"384","article-title":"Nutrition in Heart Failure: An Update","volume":"12","author":"Sandek","year":"2009","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.cardfail.2006.02.005","article-title":"Digoxin Use and Digoxin Toxicity in the Post-DIG Trial Era","volume":"12","author":"Hussain","year":"2006","journal-title":"J. Card. Fail."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Najm, A., Niculescu, A.G., Grumezescu, A.M., and Beuran, M. (2024). Emerging Therapeutic Strategies in Sarcopenia: An Updated Review on Pathogenesis and Treatment Advances. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25084300"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jacc.2016.05.019","article-title":"The HFpEF Obesity Phenotype","volume":"68","author":"Kitzman","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_56","first-page":"201","article-title":"Effect of Endurance Training on Exercise Intolerance in HFpEF","volume":"126","author":"Haykowsky","year":"2012","journal-title":"Circulation"},{"key":"ref_57","first-page":"935","article-title":"Bioelectrical impedance analysis and limitations in body composition assessment","volume":"36","author":"Sergi","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1088\/0967-3334\/27\/9\/012","article-title":"Body fluid volume determination via spectroscopy","volume":"27","author":"Moissl","year":"2006","journal-title":"Physiol. Meas."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2017.01.001","article-title":"Protein and Exercise in the Prevention of Sarcopenia and Aging","volume":"40","author":"Naseeb","year":"2017","journal-title":"Nutr. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.ejheart.2008.09.002","article-title":"Adequate Energy-Protein Intake Is Not Enough to Improve Nutritional and Metabolic Status in Muscle-Depleted Patients with Chronic Heart Failure","volume":"10","author":"Aquilani","year":"2008","journal-title":"Eur. J. Heart Fail."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s13539-010-0008-0","article-title":"The Effects of a High-Caloric Protein-Rich Oral Nutritional Supplement in Patients with Chronic Heart Failure and Cachexia on Quality of Life, Body Composition, and Inflammation Markers: A Randomized, Double-Blind Pilot Study","volume":"1","author":"Rozentryt","year":"2010","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1017\/S0007114514002475","article-title":"The Effectiveness of Leucine on Muscle Protein Synthesis, Lean Body Mass and Leg Lean Mass Accretion in Older People: A Systematic Review and Meta-Analysis","volume":"113","author":"Xu","year":"2015","journal-title":"Br. J. Nutr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/eurheartj\/ehu385","article-title":"Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency","volume":"36","author":"Ponikowski","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1002\/jcsm.12981","article-title":"Roles of Nutrition in Muscle Health of Community-Dwelling Older Adults: Evidence-Based Expert Consensus from the Asian Working Group for Sarcopenia","volume":"13","author":"Chen","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1017\/S0029665112000122","article-title":"Safety and Efficacy of High-Protein Diets for Weight Loss","volume":"71","author":"Johnstone","year":"2012","journal-title":"Proc. Nutr. Soc."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e13800","DOI":"10.1111\/ijcp.13800","article-title":"Reassessing Sarcopenia in Hypertension: STAR and ACE Inhibitors Excel","volume":"75","author":"Ata","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_67","first-page":"321","article-title":"ACE Inhibitors and Sarcopenia: Covering All the BASEs?","volume":"30","author":"Springer","year":"2013","journal-title":"Drugs Aging"},{"key":"ref_68","first-page":"476","article-title":"Use of Diuretics Is Associated with Higher Risk of Sarcopenia in Older Adults with Hypertension","volume":"35","year":"2022","journal-title":"Int. J. Cardiovasc. Sci."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s40266-015-0288-3","article-title":"Effect of Angiotensin-Converting Enzyme Inhibitors on Physical Function in Elderly Subjects: A Systematic Review and Meta-Analysis","volume":"32","author":"Zhou","year":"2015","journal-title":"Drugs Aging"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1111\/j.1365-2265.2011.04148.x","article-title":"Mineralocorticoid Antagonism: A Novel Way to Treat Sarcopenia and Physical Impairment in Older People?","volume":"75","author":"Burton","year":"2011","journal-title":"Clin. Endocrinol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1161\/01.CIR.101.6.594","article-title":"Spironolactone Increases Nitric Oxide Bioactivity, Improves Endothelial Vasodilator Dysfunction, and Suppresses Vascular Angiotensin I\/Angiotensin II Conversion in Patients with Chronic Heart Failure","volume":"101","author":"Farquharson","year":"2000","journal-title":"Circulation"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1046\/j.1365-2249.2003.02249.x","article-title":"Spironolactone Inhibits Production of Proinflammatory Cytokines, Including Tumour Necrosis Factor-\u03b1 and Interferon-\u03b3, and Has Potential in the Treatment of Arthritis","volume":"134","author":"Bendtzen","year":"2003","journal-title":"Clin. Exp. Immunol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s00223-015-0022-5","article-title":"Pharmacologic Options for the Treatment of Sarcopenia","volume":"98","author":"Morley","year":"2016","journal-title":"Calcif. Tissue Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"12435","DOI":"10.1073\/pnas.1920310117","article-title":"The \u03b2-arrestin-biased \u03b2-adrenergic receptor blocker carvedilol enhances skeletal muscle contractility","volume":"117","author":"Kim","year":"2020","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.7150\/thno.33000","article-title":"New Insights into the Pathogenesis and Treatment of Sarcopenia in Chronic Heart Failure","volume":"9","author":"Yin","year":"2019","journal-title":"Theranostics"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1080\/14779072.2018.1424542","article-title":"Therapeutic Considerations of Sarcopenia in Heart Failure Patients","volume":"16","author":"Saitoh","year":"2018","journal-title":"Expert. Rev. Cardiovasc. Ther."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.jacc.2009.04.078","article-title":"Effect of Long-Acting Testosterone Treatment on Functional Exercise Capacity, Skeletal Muscle Performance, Insulin Resistance, and Baroreflex Sensitivity in Elderly Patients with Chronic Heart Failure: A Double-Blind, Placebo-Controlled, Randomized Study","volume":"54","author":"Caminiti","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.jacc.2010.03.090","article-title":"Testosterone Therapy in Women with Chronic Heart Failure: A Pilot Double-Blind, Randomized, Placebo-Controlled Study","volume":"56","author":"Iellamo","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.sxmr.2018.09.006","article-title":"Selective Androgen Receptor Modulators: Current Knowledge and Clinical Applications","volume":"7","author":"Solomon","year":"2019","journal-title":"Sex. Med. Rev."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S1470-2045(13)70055-X","article-title":"Effects of Enobosarm on Muscle Wasting and Physical Function in Patients with Cancer: A Double-Blind, Randomised Controlled Phase 2 Trial","volume":"14","author":"Dobs","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s12603-013-0335-x","article-title":"A Phase IIA Randomized, Placebo-Controlled Clinical Trial to Study the Efficacy and Safety of the Selective Androgen Receptor Modulator (SARM) MK-0773 in Female Participants with Sarcopenia","volume":"17","author":"Papanicolaou","year":"2013","journal-title":"J. Nutr. Health Aging"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"3674","DOI":"10.1161\/01.CIR.0000149746.62908.BB","article-title":"Effects of Ghrelin Administration on Left Ventricular Function, Exercise Capacity, and Muscle Wasting in Patients with Chronic Heart Failure","volume":"110","author":"Nagaya","year":"2004","journal-title":"Circulation"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/S2213-8587(15)00298-3","article-title":"Myostatin Antibody (LY2495655) in Older Weak Fallers: A Proof-of-Concept, Randomised, Phase 2 Trial","volume":"3","author":"Becker","year":"2015","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1111\/jgs.14927","article-title":"Treatment of Sarcopenia with Bimagrumab: Results from a Phase II, Randomized, Controlled, Proof-of-Concept Study","volume":"65","author":"Rooks","year":"2017","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1007\/s11010-024-05120-y","article-title":"Therapeutic applications and challenges in myostatin inhibition for enhanced skeletal muscle mass and functions","volume":"480","author":"Wetzlich","year":"2024","journal-title":"Mol. Cell. Biochem."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/S1474-4422(19)30200-5","article-title":"Safety and efficacy of intravenous bimagrumab in inclusion body myositis (RESILIENT): A randomised, double-blind, placebo-controlled phase 2b trial","volume":"18","author":"Hanna","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1038\/d41573-025-00029-7","article-title":"First muscle-growing antibody heads to the FDA, with obesity opportunities on the horizon","volume":"24","author":"Garber","year":"2025","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s11154-025-09967-4","article-title":"New drugs for the treatment of obesity: Do we need approaches to preserve muscle mass?","volume":"26","author":"Ryan","year":"2025","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1111\/jdi.13179","article-title":"Effects of Dapagliflozin on the Serum Levels of Fibroblast Growth Factor 21 and Myokines and Muscle Mass in Japanese Patients with Type 2 Diabetes: A Randomized, Controlled Trial","volume":"11","author":"Yamakage","year":"2020","journal-title":"J. Diabetes Investig."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.amjcard.2025.08.031","article-title":"Prevalence and Prognostic Differences between Sarcopenia and Sarcopenic Obesity in Heart Failure","volume":"257","author":"Hu","year":"2025","journal-title":"Am. J. Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"107927","DOI":"10.1016\/j.phrs.2025.107927","article-title":"Glucagon-like peptide-1 receptor agonists and muscle mass effects","volume":"220","author":"Ceasovschih","year":"2025","journal-title":"Pharmacol. Res."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"263","DOI":"10.11005\/jbm.25.919","article-title":"Emerging Role of Myostatin Inhibitors in the Management of Glucagon-Like Peptide-1-Associated Sarcopenia and Metabolic Disorders","volume":"32","author":"Baik","year":"2025","journal-title":"J. Bone Metab."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1038\/nrcardio.2017.51","article-title":"Muscle Wasting and Cachexia in Heart Failure: Mechanisms and Therapies","volume":"14","author":"Ebner","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1093\/cvr\/cvae073","article-title":"Biological Basis and Treatment of Frailty and Sarcopenia","volume":"120","author":"Sato","year":"2024","journal-title":"Cardiovasc. Res."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Cho, J., Choi, Y., Sajgalik, P., Kim, D., Park, J., Lee, S., Lee, J., and Park, S. (2020). Exercise as a Therapeutic Strategy for Sarcopenia in Heart Failure: Insights into Underlying Mechanisms. Cells, 9.","DOI":"10.3390\/cells9102284"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/1741826711402735","article-title":"Exercise Training Leads to a Reduction of Elevated Myostatin Levels in Patients with Chronic Heart Failure","volume":"19","author":"Lenk","year":"2012","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Lelyavina, T.A., Galenko, V.L., Ivanova, O.A., Shlyakhto, E.V., Mareev, V.Y., Mareev, Y.V., Malovichko, S.I., and Belenkov, Y.N. (2019). Clinical Response to Personalized Exercise Therapy in Heart Failure Patients with Reduced Ejection Fraction Is Accompanied by Skeletal Muscle Histological Alterations. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20215514"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1001\/jama.2009.454","article-title":"Efficacy and Safety of Exercise Training in Patients with Chronic Heart Failure: HF-ACTION Randomized Controlled Trial","volume":"301","author":"Whellan","year":"2009","journal-title":"JAMA"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.cardfail.2006.10.017","article-title":"Circuit Resistance Training in Chronic Heart Failure Improves Skeletal Muscle Mitochondrial ATP Production Rate\u2014A Randomized Controlled Trial","volume":"13","author":"Williams","year":"2007","journal-title":"J. Card. Fail."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1152\/jappl.2001.90.6.2341","article-title":"Randomized Trial of Progressive Resistance Training to Counteract the Myopathy of Chronic Heart Failure","volume":"90","author":"Pu","year":"2001","journal-title":"J. Appl. Physiol."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Lu, L., Mao, L., Feng, Y., Ainsworth, B.E., Liu, Y., and Chen, N. (2021). Effects of Different Exercise Training Modes on Muscle Strength and Physical Performance in Older People with Sarcopenia: A Systematic Review and Meta-Analysis. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02642-8"},{"key":"ref_102","unstructured":"ClinicalTrials.gov (2026, March 08). Whey Protein Supplementation During Cardiac Rehabilitation in Heart Failure (PROT-HF). Preprint Posted Online 2017, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03004833."},{"key":"ref_103","unstructured":"ClinicalTrials.gov (2026, March 09). A SkeleTal Muscle Recovery Intervention with Dietary Protein in Heart Failure (ASTRID-HF). Preprint Posted Online 2022, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05434976."},{"key":"ref_104","unstructured":"ClinicalTrials.gov (2026, March 09). STRIVE Trial: Whey Protein Supplementation and Resistance Training in HFpEF. Preprint Posted Online 2024, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT06301560."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Curcio, F., Testa, G., Liguori, I., Papalia, R., Della-Morte, D., Gargiulo, G., Cacciatore, F., Bonaduce, D., and Abete, P. (2020). Sarcopenia and Heart Failure. Nutrients, 12.","DOI":"10.3390\/nu12010211"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/9\/1431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T12:24:10Z","timestamp":1777551850000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/9\/1431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":105,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["nu18091431"],"URL":"https:\/\/doi.org\/10.3390\/nu18091431","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}