Introduction:
Heart failure (HF) is a clinical syndrome associated with diverse metabolic disturbances. Recent studies suggest that failing heart through secretion of soluble myostatin may induce skeletal muscle wasting in HF patients and skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic HF. However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear.
Hypothesis:
We hypothesized that low appendicular skeletal muscle mass could predict the occurrence of future cardiovascular (CV) events in patients with ADHF.
Methods:
We assessed lean body mass by dual energy X-ray absorptiometry in 96 patients with ADHF (age 72±11, left ventricular ejection fraction (LVEF) 38±15%, B-type natriuretic peptide (BNP) levels on admission 752 [377-1398] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height
2
) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0kg/m
2
in male, <5.4kg/m
2
in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, or HF re-hospitalization).
Results:
ASMI significantly correlated with age (r=-0.51, P<0.001), male sex (r=0.53, P<0.001), body mass index (r=0.63, P<0.001), systolic blood pressure on admission (r=0.21, P=0.04), and BNP levels on admission (r=-0.39, P=0.04). ADHF patients with low ASMI (n=54, 56%) had higher BNP levels (968 [552-1773] versus 498 [273-943], p=0.001) and higher rate of clinical scenario 2-3 (48% versus 12%, p=0.001) than those with normal ASMI. 42 patients developed CV events (median follow-up, 16months). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low ASMI group than those in the normal ASMI group (54% vs. 29%, log-rank test, P=0.02). Multivariate Cox hazard analysis identified low ASMI as an independent predictor of the CV events in patients with ADHF (hazard ratio 2.1, 95%-confidence interval 1.1-4.2, P=0.03).
Conclusions:
Low ASMI could predict the future CV events in patients with ADHF, irrespective of LV systolic function and other clinical profile.
Physical activity, protein intake, and appendicular skeletal muscle mass in older men
