Reply to "Expanding Perspectives on Sarcopenia and Frailty Risk in Heart Transplant Recipients"

Abstract

We read with great interest the letter by Drs. Lien-Chung Wei and Hsien-Jane Chiu commenting on our recent publication in this journal [1]. In our study, we aimed to explore the presence of sarcopenia and frailty risk in a cohort of patients post heart trans-plantation (HTx) and analyze the impact of sociodemographic, lifestyle, physical, and psychological factors on these conditions [1]. We appreciate the authors' insights into our key findings and the additional perspectives they have provided. Our study indeed confirmed that functional capacity is a significant predictor of both sarcopenia and frailty risk. It is well established that post-HTx patients often experience exercise limitations due to muscle abnormalities stemming from their prior chronic heart failure (HF), comorbidities, immunosuppressive therapies, corticosteroid-induced myopathy, and deconditioning related to muscle pain or fatigue [2]. We concur that multimor-bidity is highly prevalent in post-HTx patients, and adopting a broader multimorbidity framework in future research may yield additional insights. In our sample of 133 patients, we observed that 23.3% had two or more comorbidities, including hypertension, diabetes, and/or dyslipidemia. Regarding psychological and cognitive factors, our findings revealed that both depression and kinesiophobia were associated with increased sarcopenia and frailty risk. Depression is a well-recognized factor influencing post-HTx outcomes, with prevalence rates of 35.1% for pre-transplant depression and 26.3% for post-transplant depression [3]. The suggestion to incorporate cognitive function assessments is particularly valuable, as cogni-tive dysfunction has been observed in 63.2% of post-HTx patients, as measured by the Montreal Cognitive Assessment Scale [4]. Male patients with lower education levels, older age, reduced left ventricular ejection fraction, and a history of diabetes were at an elevated risk of cognitive impairment [4]. The critical role of nutrition in post-HTx management was acknowledged in a recent clinical consensus statement, which also underscored how exercise performance is influenced by nutritional status [2]. In terms of exercise training, both aerobic and resistance training should be integrated into rehabilitation programs [2]. A prior study assessed the effects of a 12-week supervised aerobic and strength training program compared to no training on physical functioning (VO 2 peak), submaximal left ventricular systolic function, peripheral vascular function, lean soft tissue (measured using dual-energy x-ray absorptiometry), and maximal strength in clinically stable post-HTx patients [5]. The study enrolled 43 clinically stable post-HTx patients (mean age: 57 ± 11 years) at least 6 months post-transplant [5]. Participants randomized to the exercise program engaged in aerobic training (5 days per week) and resistance training