Le traitement de la sarcopénie et son impact sur les résultats des patients fragiles ayant subi une intervention cardiaque

 

Jonathan Afilalo

Hôpital général juif

 

Domaine : Santé circulatoire et respiratoire

Programme chercheurs-boursiers cliniciens - Junior 2

Concours 2016-2017

The aging population has redefined the field of heart disease from single-system disease-oriented care to multi-faceted patient-oriented care. Frailty is a syndrome seen mainly in older adults that is central to the patient-oriented care model as it reflects the individual patient's reserves and resiliency to stressful events such as surgery. My research has shown that frail patients suffer a 3-fold increase in death, complications, and poor recovery of physical function after heart surgery and other invasive heart procedures.

However, existing tools to measure frailty are limited by low specificity in hospitalized patients and ambiguity about their actionable ramifications – this is a critical barrier that has stifled the advancement of treatment strategies. The solution that I am proposing is to use a different marker to measure frailty, one that has the potential to be treated in clinical practice, namely – sarcopenia. Sarcopenia, "the biological substrate of frailty", is the age-related loss of muscle mass and strength. Various criteria exist to define it, some using special scales and others using bone density scanners, but these have not been adequately assessed in patients with heart disease who may have issues such as fluid retention that can cause inaccurate measurements.

Thus, I will compare the accuracy and prognostic value of various criteria to determine how we should optimally diagnose sarcopenia in patients with heart disease. Then, I will identify patients who are referred for heart surgery and have low muscle mass and strength (sarcopenia) to test a targeted treatment – a specialized protein supplement beverage – which was designed to stimulate muscle building in older adults, and, I hypothesize, will improve their recovery of physical function and other outcomes after the heart surgery procedure.