Adverse Hemodynamics in Acute Heart Failure Patients Are Associated with Skeletal Muscle Stress Biomarkers

Acute heart failure (AHF) causes abrupt hemodynamic disturbances, including reduced forward flow and venous congestion, which may extend beyond the heart and contribute to peripheral organ stress. Skeletal muscle may be particularly vulnerable to these changes, but the relationship between acute hemodynamic status and circulating markers of skeletal muscle stress and regulation remains unclear. We prospectively enrolled 35 men hospitalized with AHF and non-invasively assessed their cardiac index (CI) by impedance cardiography and right atrial pressure (RAP) by echocardiography. Plasma carbonic anhydrase III (CA3), creatine kinase-MM (CK-MM), lactate, myostatin, and follistatin were measured at admission, discharge, and 30 days after discharge. Patients were analyzed according to low CI, defined as CI < 2.2 L·min^-1·m^-2; elevated RAP, defined as RAP ≥ 8 mmHg; and combined CI/RAP profiles. CA3 and CK-MM were higher in patients with low CI or elevated RAP and were highest in the low-CI/elevated-RAP profile. CA3 and lactate did not significantly change during follow-up, whereas CK-MM modestly increased at 30 days. Myostatin and follistatin were highest at admission and decreased after clinical stabilization. In this pilot cohort of men hospitalized with AHF, estimated lower perfusion and greater venous congestion were associated with higher circulating markers of skeletal muscle stress, while muscle regulatory myokines declined after stabilization. These findings suggest that skeletal muscle-related biomarkers may reflect peripheral consequences of acute hemodynamic disturbance in AHF and warrant further investigation in larger cohorts.